Summary: CY 2022 Final Physician Fee Schedule

On November 2, 2021, CMS issued the final Calendar Year 2022 (CY2022) Physician Fee Schedule (PFS), which makes payment and policy changes under Medicare Part B.

View a summary produced by the Alliance for Connected Care here. Additional links are provided below:

Overview of Major Policies

CMS has finalized its proposal to retain all services added to the Medicare telehealth services list on a Category 3 basis until the end of CY 2023 – December 31, 2023. In addition, CMS is adding CPT codes 93797 and 93798 and HCPCS codes G0422 and G0423 to the Category 3 Medicare telehealth services list. These codes relate to outpatient cardiac rehabilitation and intensive cardiac rehabilitation.

CMS finalized its proposal to amend the current regulatory requirement for interactive telecommunications systems to include audio-only communication technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. CMS has also finalized policy to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology. Note that CMS had originally included an additional parameter for patients who do “not wish to use” audio-video, however, CMS has eliminated the patient’s choice to refuse audio-video in the final rule.

CMS has also finalized its proposal to require an in-person visit be provided by the physician or practitioner furnishing mental health telehealth services within 6 months prior to the initial telehealth service, and at least once every 12 months – instead of the proposed 6 months – thereafter.

CMS is allowing for limited exceptions to the 12 month in-person requirement. Specifically, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period.
CMS notes that there is no exception to the statutory requirement that the physician or practitioner must furnish to the beneficiary an in-person, non-telehealth service within 6 months prior to initiation of mental health services via telehealth.

Finally, in response to comments that CMS implement a broad definition of the term “home” in terms of mental healthcare delivery site, CMS has clarified that the definition of home can include temporary lodging, such as hotels and homeless shelters. Furthermore, CMS notes that in circumstances where the patient, for privacy or other personal reasons, chooses to travel a short distance from the exact home location during a telehealth service, the service is still considered to be furnished “in the home of an individual.”

Below is a summary of key payment and policy changes within the rule.