On Tuesday, July 13, the Centers for Medicare & Medicaid Services (CMS) released a notice of proposed rulemaking for the Calendar Year (CY) 2022 Medicare Part B Physician Fee Schedule (MPFS proposed rule). The MPFS proposed rule includes a number of important policy provisions that impact the Medicare program.
CY 2022 Medicare Conversion Factor
Of particular note, CMS has proposed a CY 2022 Medicare conversion factor of $33.5848; this represents a 3.89% reduction from the CY 2021 conversion factor of $34.8931. Almost all of the conversion factor reduction (3.75%) results from the expiration of the 3.75% increase in MPFS payments for CY 2021 were included in the Consolidated Appropriations Act 2021. The remainder of the conversion factor reduction (0.14%) results were from the CY 2022 work RVU budget neutrality adjustment.
CY 2022 Specialty Impacts
Based on the changes in the rule, including the decrease in the conversion factor, CMS projects urology will see a -3.7% change in total allowed Medicare charges for CY 2022. CMS estimates that general surgery will see a -3.8% change in total allowed Medicare charges for CY 2022 and that internal medicine will see a -2.4% change in total allowed Medicare charges for CY 2022; these estimates will vary based on an individual physician’s case mix.
CY 2022 RBRVS Updates
CMS did not propose any changes to any urology codes under the resource-based relative value scale (RBRVS). CMS proposes Medicare contractor pricing for four new periurethral adjustable balloon continence devices as recommended by the Relative-Value Scale Update Committee (RUC): CPT codes 53XX1 Periurethral transperineal adjustable balloon continence device; bilateral insertion, including cystourethroscopy and imaging guidance, 53XX2 Periurethral transperineal adjustable balloon continence device; unilateral insertion, including cystourethroscopy and imaging guidance, 53XX3 Periurethral transperineal adjustable balloon continence device; removal, each balloon and 53XX4 Periurethral transperineal adjustable balloon continence device; percutaneous adjustment of balloon(s) fluid volume.
Other Policy Changes
AUA will review the entire 1,700+ page MPFS proposed rule in detail over the coming week and will provide a deep-dive on policy changes that impact urological practice. Some of the policy changes included in the MPFS proposed rule for which the AUA will provide analysis include:
- Updates to Medicare telehealth policies;
- Updates to the Medicare Quality Payment Program, including the new MIPS Value Pathways (MVP) program;
- Updates to guidelines for split-shared visits with respect to Evaluation & Management visits;
- Updates to Medicare policy with respect to physician self-referral rules related to the Stark law.
Thank you and please be on the lookout for further updates from the around the CY 2022 MPFS proposed rule.