CMS Releases 2022 Physician Fee Schedule Proposed Rule

On July 13, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2022 Medicare Physician Fee Schedule, including many provisions that could affect radiology.

In a summary published the same day, the American College of Radiology (ACR) offered a breakdown with specifics in several areas, including appropriate use, conversion factors, and quality programs.

Here are some highlights from the ACR’s summary:

Appropriate Use Criteria (AUC): The penalty phase for the AUC/clinical decision support program is now scheduled to start on Jan. 1, 2023, or the first day of the year after the officially declared end of the COVID-19 pandemic. CMS proposed many solutions to the claims processing issues that have delayed implementation thus far, and the ACR is currently reviewing those proposals.

Conversion Factor and Estimated Payments: For calendar year 2022, CMS estimates a conversion factor of $33.5848 compared to $34.8931 from calendar year 2021. This would result in a 2-percent decrease for radiology, a 9-percent drop for interventional radiology, a 2-percent reduction for nuclear medicine, a 5-percent decline for both radiation oncology and radiation therapy centers.

Valuation of Services: CMS has proposed to accept all RVS Update Committee recommendations for values for five new or revised codes that will impact radiology. This includes increased values for needle biopsy of lymph nodes and value improvements for the new trabecular bone score code family.

National Coverage Determinations: The agency has proposed removing the national coverage determination for PET scans, deferring coverage decisions to local Medicare Administrative Contractors. Leaving these decisions up to local contractors could give Medicare beneficiaries better access to PET scans for non-oncologic indications, according to CMS.

Quality: CMS proposed removing several quality benchmark measures radiologists have historically used when reporting through the ACR National Radiology Data Registry Qualified Clinical Data Registry. These include:

• #21 Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second-Generation Cephalosporin
• #23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
• #144 Oncology: Medical and Radiation – Plan of Care for Pain
• #154 Falls: Risk Assessment
• #195 Radiology: Stenosis Measurement in Carotid Imaging Reports
• #225 Radiology: Reminder System for Screening Mammograms
• #317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

To read the ACR’s full summary, click here.

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