Fee schedule round-up: Payment and policy updates

Why This Topic Matters

The proposed rule touches multiple operational areas that can affect reimbursement, coverage decisions, compliance workflows, and future reporting requirements across Medicare-participating practices and suppliers.

Article Sections

1. Physician payments

   General overview of payment-related proposals in the 2022 Medicare physician fee schedule. This section introduces several policy areas that affect reimbursement and billing workflows.

2. Therapy assistants and payment adjustments

   Discussion of proposed changes affecting therapy assistant payment adjustments and related billing considerations. The section focuses on how CMS is approaching therapy-related payment policy.

3. National coverage determinations proposed for deletion

   Coverage-policy updates involving older Medicare national coverage determinations proposed for retirement. The section explains the broader context for deletion and local contractor coverage authority.

4. Potentially misvalued codes

   A review of nominated services CMS considered in connection with its misvalued-code process. The section highlights the agency’s request for comment and valuation review context.

5. Practice expense updates for specialty data

   Information on practice expense data updates for selected specialties. The section addresses how CMS is incorporating utilization and crosswalk data into fee schedule support files.

6. Therapy codes and practice expense reassignments

   Proposed revisions to practice expense treatment for certain therapy-related CPT services. The section discusses CMS’s approach to future indirect practice expense values.

7. Supply, equipment, and clinical labor pricing updates

   Updates affecting supply and equipment pricing, along with clinical labor pricing revisions used in practice expense calculations. The section references tables and broader specialty impact considerations.

8. Retinal-imaging code valuation and emerging technology

   Proposed valuation work for a retinal-imaging service and broader CMS questions about innovative technology in code valuation. The section frames the issue as part of ongoing pricing methodology discussions.

9. Pulmonary, cardiac, and intensive cardiac rehab alignment

   Proposals to align terminology and requirements across Medicare rehabilitation programs. The section also notes pandemic-related rehabilitation considerations.

10. Enrollment revisions and screening copay changes

    Changes related to provider enrollment authority and a phased policy adjustment for colorectal cancer screening cost-sharing. The section addresses broader compliance and beneficiary cost-sharing policy updates.

11. Specimen collection, self-referral, and controlled substance rules

    A group of policy updates touching specimen collection fees, Stark self-referral provisions, and controlled-substance prescribing requirements. The section covers several operational compliance topics.

12. Open Payments Program changes

    Proposed revisions to the Open Payments Program for a future data collection year. The section summarizes reporting, certification, and ownership-related updates.

13. Vaccine payment revisions and COVID-19-related payment issues

    CMS proposals and requests for comment on vaccine administration payment and related COVID-19 payment topics. The section addresses preventive vaccine administration and home-based vaccination issues.

14. Part B drug payment

    Part B drug payment process questions and technical changes under discussion. The section focuses on application and payment-policy review issues for certain drug categories.

15. Appropriate use criteria delay

    A further delay in the implementation of the Medicare appropriate use criteria program. The section explains the program timing context and related operational implications.

16. New medical review contractor authority

    Proposed authority for contractors handling prepayment and post-payment medical reviews. The section addresses documentation requests, denials, and related review procedures.