Medicare Physician Fee Schedule (MPFS)
The MPFS for Fiscal Year (FY) 2022 was released on Tuesday November 2nd, 2021 and went into effect on January 1st, 2022. The MPFS impacts Medicare Part B services and billing.
While there were numerous changes, the primary item related to therapy is a 15% payment cut to services provided by assistants with the CO (OT Assistant)/CQ (PT Assistant) modifier applied. The 15% cut is applied to the 80% Medicare pays for each CPT code. Although CMS further clarified when the modifiers are to be applied, the CO/CQ modifiers have been in place since January 1st, 2020. Like the application of the modifiers, Software Vendors should set their systems to make appropriate calculations.
In addition, the KX Modifier Threshold was updated to $2150 for OT and $2150 for PT and SLP. The Manual Medical Review Threshold remains $3000 through 2028.
It is anticipated Congress will address the Medicare Physician Fee Schedule in February 2022 given the significant impact this final rule has on various providers.
To learn more go to https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched.
National Correct Coding Initiative (NCCI) Edits
The updated version of the NCCI Edits was posted on December 15th, 2021 and became effective January 1st, 2022. This includes updates to the Procedure to Procedure (PTP) Coding Edits, the Medically Unlikely Edits (MUEs), and the Add-On Code Edits. For therapy, one of the big items on the PTP Coding Edits is deletion of the CPT code pair 97530 and 97535.
To see the latest updates go to https://www.cms.gov/Medicare/Coding/NCCI-Coding-Edits.
Omnibus COVID-19 Health Care Staff Vaccination
On December 28th, CMS released their guidance on the Interim Final Rule for COVID-19 Health Care Staff Vaccination. The guidance included a memo describing the overall rule and enforcement. CMS additionally published guidance for each of the various care settings. Here are the links to the general memo and the guidance for Long Term Care:
Please note this rule currently applies in 25 states and the District of Columbia and remains under injunction in the remaining 25 states. The Supreme Court is scheduled to hear arguments on January 7th regarding this Interim Final Rule as well as the OSHA ETS Vaccine Mandate for Employers with a 100 or more Employees.
Payroll Based Journal (PBJ)
Reminder PBJ data is due on February 14th, 2022 for the period of October 1 through December 31, 2021. Refer to the following webpage for more information: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.
Patient Driven Payment Model (PDPM)
Implementation of the latest version of the PDPM Grouper V2.0002 will start on Thursday January 6th. The new and updated Grouper corrects issues with the NTA comorbidities mapping and addresses a security vulnerability.
Public Health Emergency (PHE)
The PHE is set to expire on January 16, 2022. However, CMS has stated they will provide 60 days-notice prior to the end of the PHE, indicating it will again be extended.
In addition, a number of waivers will not expire until the end of the year in which the PHE ends giving Providers some extended relief.
For information on the PHE and current waivers and flexibilities refer to the following links: