The Centers for Medicare and Medicaid Services (CMS) have released their proposed rule for 2022, which includes an updated physician fee schedule (PFS), new remote monitoring codes, and payment cuts. As always, CMS has opened a 60-day comment period, which will close on September 17, 2021.
Understanding Medicare compliance is hard enough, but reading through over 1,700 pages of CMS legalese? We can’t blame you if you’re looking for the cliff notes. So, to help you stay informed and active in shaping outpatient rehab therapy, we’ve compiled some of the most important details on the latest proposed rule and how you can get involved.
The bad news: more cuts on the way
CMS is working its way towards a 9% cut by 2024, and next year could see a cut of 3.75% for physical, speech, and occupational therapists if the proposed rule becomes finalized.
Last year, Congress was able to step in and prevent substantial cuts to outpatient rehab therapists, reducing the initial 9% planned cut to only 3.3% by approving an additional $3 billion in funding to CMS during the pandemic. However, CMS still has its eyes on deep cuts to the conversion factor for outpatient evaluation and management service CPT codes. Without the additional funds from Congress, CMS will reduce the conversion factor from $34.89 to $33.58 (a 3.75% reduction) for these CPT codes, as was initially planned for 2021.
Many providers will feel the impact of these lower CPT code reimbursements, but physical, speech, and occupational therapists will bear the brunt of the cuts. Luckily, advocates with APTA, AOTA, ASHA, and other stakeholders are working hard to pressure Congress and CMS for additional funding.
The 15% PTA and OTA cut
As anticipated, CMS is still moving forward with a 15% reduction in reimbursement for any services billed with a CO or CQ modifier. The CO or CQ modifier signifies services performed entirely or partially by a therapy assistant. CMS has also provided further guidance on the proper use of the CO or CQ modifier, including incorporating the 8-minute rule, according to the AOTA1.
Better news: RVU increases and new RTM codes
While some therapy CPT codes are being cut, CMS is also increasing some relative value units (RVUs) for PT and OT codes in 2022. One of the most significant changes will impact the RVUs for occupational therapy evaluation (97165-97167), although APTA notes2 that the changes won’t be enough to offset the loss in income from the proposed 3.75% cut to the conversion factor.
For SLPs, three new remote therapeutic monitoring (RTM) codes will be added that may be useful:
[Note: codes are subject to change based on final ruling by CMS]
- 989X1: Remote therapeutic monitoring; initial set-up and patient education on use of equipment
- 989X4: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional team in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes
- 989X5: Each additional 20 minutes (list separately in addition to code for primary procedure)
According to ASHA3, the above codes are considered “general medicine codes” by CMS. Certain nonphysician providers, like SLPs, OTs, and PTs, may not be able to bill these codes as currently written, although CMS is actively seeking comments on how to structure these codes for nonphysician providers.
And in other news: MIPS and the rapid evolutions towards value-based care
CMS continues to ratchet up the performance threshold for those participating in MIPS. Proposed for the 2022 performance year, the performance threshold now stands at 75 points with an exceptional bonus threshold of 89 points.
But one important thing to note is that 2022 marks the first year that the scoring thresholds were set by baselines from prior years (based on a rule written into MACRA in 2015). The hope is this change will boost the bonus payment pool and reward providers who deliver high-quality, low-cost care. Should you do well in MIPS, this means your bonus payout in the 2024 payment year could be much higher than in previous years.
In the 2022 proposed rule, CMS also proposed to delay implementing the new MIPS Value Pathways (MVPs) until 2023. Additionally, CMS is proposing to end the traditional MIPS program after the 2027 performance year, in favor of MVP and Alternative Payment Models (APM) participation.
And, believe it or not, there is much more to learn about MIPS, MVP, and the changes coming in the 2022 proposed rule. Join our friends over at Keet Health for a webinar about the proposed rule, happening August 18th, at 10AM (Pacific Time). Register today to learn about how you can prepare for 2022 and get your questions answered by industry experts!
Where to find more information
We’ve only scratched the surface of some of the biggest changes CMS is imposing on outpatient rehab therapy. Visit these sites to learn about telehealth coverage after the pandemic, advanced payment models, and more:
- See the full 2022 proposed rule on the Federal Register (released 07/23/2021)
- 1Learn about changes impacting occupational therapy from the AOTA
- 2Learn about changes impacting physical therapy from the APTA
- 3Learn about changes impacting audiologists and SLPs from the ASHA
How can you send a comment to CMS?
We’re so glad you asked! CMS accepts comments through mail or online submission:
- Submit comments online at Regulations, click the “submit a comment” tab, and follow the instructions.
- Mail comments to:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
P.O. Box 8010, Baltimore, MD 21244-1850
The comment submission period ends Friday, September 17, 2021.
Get involved and have your voice be heard!
IMPORTANT NOTICE: The information provided herein is intended to be general in nature. It is not offered as legal or insurance-related advice and is not a complete description, or meant, or intended, to replace or be interpreted as specific, of Medicare requirements. Although every effort has been made to ensure the content herein is correct, we assume no responsibility for its accuracy. Contact the Department of Health & Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS) for more information on the proposed rule for 2022.