- 2025 code changes: What doctors of optometry need to know
- Introducing the new CMS G2211 code
- Coordination of benefits 3 takeaways for optometric billing practices
- Clearing up modifier confusion
- Payor Downcoding: What Is It and What Should You Do About It
- New noteworthy optometry codes
- Modifier -25: How to use it appropriately and avoid costly penalties
- 3 coding questions cracked
- CPT codes deleted in 2023—do you know what codes may be billed to replace them?
- Why Proper Documentation Is Vital
- Common coding questions answered
- How and when to code for social determinants of health
- Most asked coding questions: dilation
- What does COVID-19 PHE ending mean for telemedicine
- 2 points to keep in mind when patients decline dilation
- social determinants of health
- Can a doctor of optometry bill Medicare for a comprehensive eye exam and a procedure on the same day
- The future of audio-only reimbursement
- Coding conundrums solved
- 7 takeaways from the 2023 Medicare Physician Fee Schedule Final Rule
- Virtual check-in codes
- What your colleagues are asking about coding
- CMS releases 2023 Medicare PFS proposed rule
- Merit-based Incentive Payment System: What doctors should know
- Ask the coding experts
- Merit-based Incentive Payment System quality measures
- Coding for presbyopia eye drops
- Coding and contact lens safety
- CMS releases information on Part B claims-based quality measure scoring for 2021
- Updated ICD-10 codes take effect October 1
- If it sounds too good to be true
- New EM codes
- What to do when a coding decision is made incorrectly
- 4 coding changes now in effect
- changes in 2021 to coding and documentation for evaluation and management services.
- AOA HPI provides coding benchmark data
- Appropriate use of modifier 25
- Changes on the horizon for evaluation and management services
- AOA Coding Experts gain AMA CPT appointments
- 2020 PFS changes for optometry
- 2020 updates to the ICD-10 code set
- Medicares virtual check-in codes
- The importance of accurate coding and contact lens safety
- coding for cognitive development test
- Medicare evaluation and management documentation and billing
- Coding and audits
- 5 coding queries cracked
- appropriate diagnosis code reporting
- Diagnostic code changes
- 4 coding conundrums clarified
- Where coding and coverage intersect
- Changes on the horizon for evaluation and management documentation and reimbursement
- Global period data collection and possible future changes
- New ICD-10 codes effective
- July-Aug17_Coding Q&As
- The ICD 10 code development process
- coding experts-billing for post-cataract glasses
- accurate coding for public health
- July Aug 2017 Coding Experts
- September Coding Experts
- CMS data collection on postoperative visits
- 3 solutions to common coding problems
- 3 coding changes doctors need to know
- Coding cases cracked
- New diabetes related diagnosis codes
- Get answers to your coding questions
- New ICD10 codes doctors need to know
- Be aware of changes for 2017 and beyond
- Common coding Qs answered
- Coverage indications limitations and medical necessity
- 4 tips for competing with online retailers
- Coding questions cracked
- Access online coding resource for AOA members
- What is the future of CPT coding
- CMS makes changes in how doctors revalidate Medicare enrollment information
- 5 coding changes and clarifications doctors need to know
- More ICD 10 coding Q&As
- Doctors of optometry could see a rise in labor costs under new federal overtime rule
- 4 tips for growing your practice
- HHS unveils proposed rule for new Quality Payment Program
- Ask the Coding Experts Comparative billing reports raise questions on glaucoma patient treatment and coding
- Ask the Coding Experts Modifier 24 and 25 usage
- ICD-10 coding QandAs October
- Ask the Coding Experts Chronic care management services
- ICD 10 transition So far so good
- CMS comparative billing reports What you need to know
- Ready resources for the ICD 10 rollout
- Coding Q&As
- Online payment option makes cents
- Modifiers for distinct procedural services
- Get a refresher on your public Open Payments data
- Final countdown Get answers to your ICD-10 coding questions
- AOA clarifies meaningful use rule on electronic order entry
- More ICD 10 coding QandAs
- Vision therapy coding
- Medicare claims and requests for additional documentation
- Coding QnAs May
- Referring ordering and form 8550
- Reporting code 92250
- One-year Medicare payment fix extends ICD-10 deadline
CMS’ 2022 Medicare PFS decreases conversion factor, sets new policy goals
November 10, 2021
The final rule includes a list of updated payment policies, quality measures adjustments and telehealth changes for the 2022 calendar year. How AOA’s input shaped rulemaking and what it means for doctors.
Act now to prevent Medicare cuts
Urge your members of Congress to immediately address all three Medicare payment cuts now targeting physicians by visiting the AOA Action Center. Or text “PAYMENT” to 855.465.5124 to access the Action Center today.
Medicare physicians’ payments still hang in the balance without Congressional action as the 2022 Physician Fee Schedule (PFS) finalizes cuts and other program changes that affect optometry in the new year.
On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) published a final rule that updates policy changes for Medicare payments under the PFS for the calendar year (CY) 2022, reflecting a broader administration-wide strategy for accessibility, quality, affordability, empowerment and innovation, the agency says. The final rule, taking effect Jan. 1, 2022, does reflect the AOA’s advocacy during the rulemaking process on a range of issues, spanning updates to billing and coding, Merit-based Incentive Payment System (MIPS) categories, the much-maligned, rate-setting and conversion factor, and much more.
Conversion factor, payment decreases
In July, CMS issued its proposed policy changes with a conversion factor decrease of $1.30 over the CY 2021 conversion factor, bringing the CY 2022 conversion factor to $33.59. The decrease is on account of the budget neutrality adjustment for changes in relative value units (RVUs) and expiration of the temporary, 3.75% payment increase provided for in the Consolidated Appropriations Act 2021 to offset scheduled PFS cuts.
Such is the case, Medicare physicians now stand to see a nearly 10% decrease in 2022 reimbursement due to a perfect storm of payment reductions—the original 3.75% PFS cut, a 2% cut for Medicare sequestration and a 4% Statutory Pay-As-You-Go (PAYGO) cut triggered by federal pandemic spending.
While the AOA raised concerns with the conversion factor and potential impact on reimbursement during the PFS rulemaking, ultimately, it’s Congress that has the power to address this issue and CMS noted the agency is bound by statute to make these adjustments.
The AOA and optometry’s advocates are calling on Congress to waive the Statutory PAYGO implications, as well as extend the temporary 3.75% payment adjustment through at least 2022. As recently as Oct. 14, a U.S. House-led letter to congressional leaders had urged an immediate remedy for these impending cuts. But more support is needed to ensure congressional action to prevent these cuts, and here’s how:
- Visit the AOA’s Action Center to urge your members of Congress to immediately address all three Medicare payment cuts now targeting physicians. Or text “PAYMENT” to 855.465.5124 to access the Action Center.
Communication Technology-Based Services (CTBS)
The AOA supported—and CMS finalized—a proposal to permanently establish separate coding and payment for the longer virtual check-in service described by Healthcare Common Procedure Coding System (HCPCS) code G2252. The CMS agreed to work with the Current Procedural Terminology (CPT) and Specialty Society Relative Value Scale Update Committee (RUC) to value the service, using the value of CPT code 99442 as a crosswalk to the G code with national pricing for 99442 at $92.82.
Evaluation and management (E/M) visits
Beginning in 2023, the CMS will implement a policy wherein the physician or practitioner who spent more than half the total time will bill for the primary E/M visit and the prolonged service code(s) when the service is furnished as a split (shared) visit, if all other requirements to bill for the services are met. The physician and non-physician practitioner will add their time together, and whomever furnished more than half of the total time, including prolonged time, will report both the primary service code and the prolonged services add-on code(s), assuming the time threshold for reporting prolonged services is met. Notably, this is only for E/M services performed in a facility setting and not a physician’s office.
Telehealth eye exam
As the CMS continues to evaluate the inclusion of telehealth services that were temporarily added during the COVID-19 public health emergency, the agency finalized certain services added to the Medicare telehealth services list through Dec. 31, 2023. The AOA raised concerns with the inclusion of the eye exam codes on the telehealth covered services list, yet CMS did not address these codes. However, it did note that all services on the current telehealth covered services list would remain until 2023.
Medicare Diabetes Prevention Program (MDPP) expanded model
The CMS announced steps to improve its MDPP expanded model permitting local suppliers to provide Centers for Disease Control and Prevention (CDC)-approved curriculum for training in dietary change, increase physical activity and weight-loss strategies. The AOA supported bringing the MDPP expanded model into full alignment with the CDC’s National DPP, including:
- Eligibility to participate
- A screening standard FPG range (100-125 mg/dl)
- The use of A1c test results to establish a diagnosis of prediabetes
- Same choices of delivery modality, including online and distance-learning modalities
The CMS agreed to waive the Medicare enrollment fee for all organizations that apply to enroll as an MDPP supplier on or after Jan. 1, 2022. Additionally, the CMS shortened the MDPP services period to the one-year model instead of the current two-year model, making delivery of MDPP services more sustainable, reduce the administrative burden and costs to suppliers, and improve patient access by making it easier for local suppliers to participate and reach their communities. Finally, the CMS notes it will restructure payments, so MDPP suppliers receive larger payments for participants who reach milestones for attendance.
Quality Payment Program (QPP) changes
The final rule also proposed several changes to QPP measures that the AOA provided feedback on during rulemaking, including:
- MIPS Value Pathways (MVPs). The CMS agreed with the AOA and delayed MVPs until 2023, beginning with an initial set of MVPs.
- Quality measure benchmarks. Instead of using benchmarks for the CY 2022 performance period/2024 MIPS payment year based on the actual data submitted during the CY 2022 performance period, the CMS agreed with the AOA and opted to use data from the CY 2020 performance period/2022 MIPS payment year and will allow clinicians advanced notice of performance targets to aid in measure selection and help clinicians to work toward improvement on quality measures.
- Promoting Interoperability (PI) category. While the AOA advocated for an exemption for the new objective requiring an annual self-assessment of the high priority practices listed in the Office of the National Coordinator for Health IT (ONC’s) SAFER Guides, the CMS noted this measure will be required—just not scored—in the CY 2022 performance period/CY 2024 MIPS payment year.
- Quality Measure Reporting via Claims: The Age-Related Macular Degeneration (AMD): Dilated Macular Examination quality measure (measure 14) will no longer be allowed to be reported via Part B claims in 2022.
Diabetes eye exam quality measure revision
Significantly, the CMS finalized a change to the measure numerator for the diabetes eye exam quality measure. This revision opens the possibility of artificial intelligence interpretation of fundus photography results. While the AOA raised concerns with this approach, the CMS suggested the AOA work with the quality measure developer to further refine the measure. The AOA continues to advocate on this issue.
2022 total allowed charges
Lastly, the CMS estimates that doctors of optometry will have total allowed charges of $1.38 billion in 2022, as compared to $1.33 billion in 2020 and $1.30 billion in 2019.