CMS Proposes New Medicare Physician Payment Rule

On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022.
The public comment period will close on September 13, 2021.
For CY 2022, CMS is proposing a conversion factor of $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. This proposed conversion factor takes into account the proposed budget neutrality adjustment to account for changes in relative value units required by law, and expiration of the temporary 3.75% payment increase provided for CY 2021 by the Consolidated Appropriations Act, 2021.
AHCA/NCAL is still analyzing the proposed rule, but upon initial review, it appears that:
  • Net Part B therapy payments will be reduced by approximately 2%, a significantly less cut than expected. 
  • Proposed coding policy changes are intended to resolve problems with reporting Part B physical and occupational therapy assistant services on claims. This will minimize the impact of implementing therapy assistant payment adjustments that start in CY 2022.
  • Improvements to proposed policies and rates for SNF resident-related services, including portable x-ray, clinical lab, and vaccine administration. 
  • CMS proposes to extend the retention of all services added to the Medicare telehealth services list (including several physician and therapy services) on a temporary Category 3 basis beyond the COVID-19 public health emergency end date for further evaluation until the end of CY 2023, and favorably modify other related policies regarding coverage of other communications technology.
  • CMS is proposing several modifications to the Medicare Shared Savings Program that may impact SNF providers participating in Accountable Care Organizations.
You can review the proposed physician fee schedule on and supporting files on the CMS website. AHCA/NCAL will conduct a more in-depth review and share any further details and/or resources to assist members, if necessary.

Staff contact: Angela Westhoff