The Medicare 2022 Physician Fee Schedule

January 12, 2022

A Quick Overview of the Medicare 2022 Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released the Medicare Physician Fee Schedule (PFS) Final Payment Rule for 2022, which took effect on January 1. Unless otherwise indicated, the new policies in the 2022 physician fee schedule will apply to payments under the Medicare PFS for services delivered on or after Jan. 1, 2022.

Here are some highlights of the 2022 fee schedule:

Telehealth and related services:

As a result of the COVID-19 public health emergency (PHE), CMS greatly expanded the scope and type of services that were eligible to be delivered via telemedicine. CMS is extending the temporary inclusion of certain services on the approved telemedicine list through the end of 2023, and will continue to gather data on whether these changes should be permanent.

Under the Consolidated Appropriations Act of 2021, geographic restrictions were eliminated for telehealth services provided for mental health disorders, and the patient’s home was added as an allowed originating site for the telehealth service. Accordingly, for mental health disorders only, CMS finalized language to permanently eliminate geographic restrictions for telehealth services provided for the purpose of diagnosis, evaluation or treatment. As a condition of telehealth coverage for these services, the patient must have had an in-person visit with the rendering health professional within six months prior to the initial telemedicine service, and must have subsequent in-person visits at least every 12 months. Consistent with language in the SUPPORT for Patients and Communities Act, telehealth services provided for the treatment of a diagnosed substance use disorder or co-occurring mental health disorder are not subject to the in-person visit requirements.

Also for mental health disorders only (including substance use disorders), CMS is permitting the use of audio-only communications technology for mental health telehealth services under certain conditions when provided to established patients. Coverage for audio-only services is only available in cases in which physicians have capability of providing two-way audio-visual services, but the beneficiary is unable to use, does not wish to use, or does not have access to two-way audio/video technology. A modifier is required for billing services under these circumstances. Note that CMS will continue to cover audio-only telehealth services for non-mental health disorders only through the end of the COVID-19 PHE.

Virtual check-in services

CMS is establishing a permanent separate coding and payment for longer virtual check-in services. The new code will be used to describe 11 to 20 minutes of medical discussion when the patient health issue may not necessarily require a visit, but assessing the needs of the patient may take additional time.

Electronic prescribing of controlled substances:

The SUPPORT Act, signed into law in 2018, required electronic prescribing of Schedule II, III, IV and V controlled substances under Medicare Part D, effective Jan.1, 2021. The 2021 final rule announced a compliance date for the mandate of Jan. 1, 2022, to encourage prescribers to begin following electronic prescribing practices, while also allowing a period of transition before a compliance process is implemented. The 2022 final rule extends the compliance date to January 2023, and to January 2025 for prescriptions written for beneficiaries in long-term care facilities. Compliance will initially be enforced by CMS through communication to prescribers who do not meet the 70% threshold of e-prescribing of controlled substances prescribed under Medicare Part D.

The final rule also allows these exceptions to the Electronic Prescribing for Controlled Substances (EPCS) requirement:

• The prescriber and dispensing pharmacy are the same entity;
• The prescriber issues 100 or fewer controlled substance prescriptions for Part D drugs per calendar year;
• The prescriber is in the geographic area of an emergency or disaster declared by a federal, state or local government entity, or
• The prescriber has been granted a CMS-approved waiver based on extraordinary circumstances, such as technological failures, cybersecurity attacks or other emergencies.

Prescribers will be allowed to request a waiver in which circumstances beyond the prescriber’s control prevent the prescriber from being able to comply with the EPCS mandate.

Learn more about the Medicare Physician Fee Schedule Final Payment Rule for 2022. You may also contact the ISMS Health Policy Research and Advocacy team by email with your questions.