21 Feb 2022 CPT Updates
This article is a continuation of our previous article on the fee schedule updates announced by CMS for CY 2022 which may be relevant for your billing cycle and highlights important revisions in specific services.
Billing for Physician Assistant Services
For CY 2022, CMS has implemented the policy to make direct payment to PAs for the services they provide, instead of requiring that only a PA’s employer or independent contractor must bill for his/her services. Effective January 1 2022, payment for PA services will be 85% of what is paid to a physician under the MPFS. This change under the PA statutory benefit category now provides PAs with the option to reassign payment directly for their services or incorporate with other PAs and bill the program for PA services.
Therapy services
CMS will reduce the payment for physical therapy and occupational therapy services at 85% of the otherwise applicable payment amount for these services when a Physical therapy Assistant/Occupational therapy Assistant provides them either in whole or in part. The modifiers CQ (physical therapy service provided in whole or in part by a physical therapy assistant) and CO (occupational therapy service provided in whole or in part by an occupational therapy assistant) are used if the de minimis policy to determine the extent of these services provided PTA/OTA is met (10% or more of total therapy time). This policy is now revised to follow the ‘mid-point rule’, that is providing at least 8 minutes of service in a 15 minutes unit. In such cases, the Physical therapist/Occupational therapist can bill the final unit of a multi-unit scenario without the CQ/CO modifier. Modifiers CQ and CO will continue to be used in the following cases:
Medical Nutrition Therapy Services
Medical nutrition therapy services will be paid at 100 percent (instead of 80 percent) of 85 percent of the MPFS-approved amount without patient cost sharing. CMS specified that registered dietitian or nutrition professional services are provided on an assignment basis and clarified that referral for MNT services must be from a physician and that "co-signatures" from another provider type do not qualify.
Additional procedures during colorectal cancer screening tests
Medicare reduced the coinsurance amount for other procedures done along with colorectal cancer screening tests in the same clinical encounter as the screening test. The reduced coinsurance will be phased-in accordingly: CY 2020 – 20 percent; CY 2023-2026 – 15 percent; CY 2027-2029 – 10 percent; CY 2030-onward – zero percent. The reduction over time of the coinsurance percentage holds true regardless of the code that’s billed for: Establishment of a diagnosis, Removal of tissue or other matter or Another procedure that’s provided in connection with and in the same clinical encounter as the screening. Medicare will pay the difference.
Teaching Physician Services
For CY 2022, payment can be made to teaching physicians when they select total time as their E/M visit level to bill for office/outpatient E/M visits that involve care by their residents. However, this payment to teaching physicians under the MPFS includes only the total time that the physician is present during
the visit and just not the resident’s time.
In totality, there have been a massive 405 coding related changes in current CPT codebook, instituted by AMA, and 211 ICD-10 coding updates by CMS, for the year 2022. In our blogs, we have reviewed some noteworthy changes which are relevant for physicians, facilities and other healthcare professionals to provide utmost patient care and also ensure clean claim submission, and will continue the trend in our subsequent blogs too.
At Curemed solutions, our team of individuals with multiple years of experience in the field of medical coding and healthcare, ensure they remain abreast with all updates that are essential for accurate coding and billing and assist you in achieving timely and maximal reimbursements for your services.
