Medicare Update

Congress, under pressure from physician lobbying groups, stepped in to avoid the cuts with the PROTECTING MEDICARE AND AMERICAN FARMERS FROM SEQUESTER CUTS ACT that became law on December 10, 2021. The act helps mitigate a few negative updates for the Medicare Fee Schedule.   

Here is a short update.   

  1. The conversion factor update was scheduled to result in a -3.81% update.  The act infused the Medicare program with additional funds to significantly lessen this impact.  The result is a conversion factor of $34.6062 net change of -0.81% from last year. 
  2. Sequestration delayed.  The act suspends the full sequestration cuts of 2% through March 31, 2022, and phases the sequestration cut in with a 1% cut from April 1 – June 30, 2022.  The full 2% sequestration adjustment will begin July 1, 2022.  This delay will likely be funded with an increase in the sequestration adjustment in future years, likely to begin in 2023 unless other action is again taken by Congress. 
  3. PAYGO suspension.  The PAYGO law would have required an additional 4% reduction in Medicare payments for 2022.  The act suspended this requirement for one year.  Funding was not appropriated and must also be addressed in the future. 
  4. The Radiation Oncology and Radiation Therapy Centers demonstration project was delayed until 2023. 
  5. Cuts to the Clinical Lab Fee schedule have also been delayed for one year. 

The RVU impact for Urology overall is 0.0%.  The final rule adopted an update to the way clinical lab costs are calculated relative for adjustments in Practice Expense RVUS but allowed a 4-year phase-in of the updated clinical labor rates which will allow practices to be able to adjust to this change.  MS will use the median Bureau of Labor Statistics (BLS) wage data instead of the mean wage data and use the 2021 BLS fringe benefits multiplier of 1.296 as opposed to the 2002 BLS fringe benefits multiplier of 1.366.  These phased-in changes will help mitigate the sudden and significant change to urology practices, or at least in the short run.  Practices will need to evaluate how this affects them both for 2022 and for years to come. 

As noted above the RVU changes for 2022 when adjusted for volume across all Urologists is projected to be 0%.   The global look at RVU changes does not tell the entire story and will not apply equally to all Urologists. 

The codes listed in the Tables below are a sample of fee changes for the biggest changes for next year in the office broken down by increases and decreases and the Facility/HOPD/ASC in the 3rd table. 

In all the relief, while appreciated by the Medical community, does not adequately address the increased costs of running a medical practice and we are left with a somewhat empty celebration of the changes. Every little bit helps. Of course, lobbying efforts will need to continue as the currently required payback of items 2-5 is slated at this point to begin in 2023. 

We would also like to provide you with a few additional updates and rule changes that need to be addressed in 2022. 

Office Fees Decreasing – Sample

50200   Renal biopsy perq -3.07%
50382   Change ureter stent percut -5.00%
50384   Remove ureter stent percut -3.01%
50385   Change stent via transureth -4.69%
50592   Perc rf ablate renal tumor -6.86%
50593   Perc cryo ablate renal tum -7.26%
50606   Endoluminal bx urtr rnl plvs -15.80%
50693   Plmt ureteral stent prq -3.09%
50706   Balloon dilate urtrl strix -6.14%
51784 TC Anal/urinary muscle study -5.49%
52007   Cystoscopy and biopsy -3.83%
52010   Cystoscopy & duct catheter -3.16%
52332   Cystoscopy and treatment -7.34%
52441   Cystourethro w/implant -5.24%
52442   Cystourethro w/addl implant -8.55%
52647   Laser surgery of prostate -3.26%
52648   Laser surgery of prostate -3.27%
53850   Prostatic microwave thermotx -6.51%
53852   Prostatic rf thermotx -6.12%
53854   Trurl dstrj prst8 tiss rf wv -5.48%
53855   Insert prost urethral stent -7.85%
55200   Incision of sperm duct -4.17%
55250   Removal of sperm duct(s) -4.72%
55873   Cryoablate prostate -5.44%
55874   Tprnl plmt biodegrdabl matrl -5.67%
57465   Cam cervix uteri drg colp -4.41%

Office fees Increasing -Sample

50430   Njx px nfrosgrm &/urtrgrm 3.61%
50431   Njx px nfrosgrm &/urtrgrm 8.53%
50690   Injection for ureter x-ray 4.44%
51715   Endoscopic injection/implant 3.13%
51725 TC Simple cystometrogram 3.37%
51785 TC Anal/urinary muscle study 4.95%
51785   Anal/urinary muscle study 3.81%
51792 TC Urinary reflex study 3.71%
51797 TC Intraabdominal pressure test 7.78%
51797   Intraabdominal pressure test 6.36%
52000   Cystoscopy 4.92%
52310   Cystoscopy and treatment 3.60%
53620   Dilate urethra stricture 5.95%
53621   Dilate urethra stricture 6.31%
53860   Transurethral rf treatment 3.52%
54240 TC Penis study 3.53%
54250 TC Penis study 6.81%
56405   I & d of vulva/perineum 6.06%
56420   Drainage of gland abscess 7.57%
56441   Lysis of labial lesion(s) 4.86%
56501   Destroy vulva lesions sim 7.08%
56515   Destroy vulva lesion/s compl 4.29%
56605   Biopsy of vulva/perineum 3.09%
57020   Drainage of pelvic fluid 6.12%
57061   Destroy vag lesions simple 7.20%
57065   Destroy vag lesions complex 4.50%
57105   Biopsy of vagina 4.67%
57130   Remove vagina lesion 4.89%
57135   Remove vagina lesion 4.35%
57150   Treat vagina infection 3.21%
57170   Fitting of diaphragm/cap 3.61%
57180   Treat vaginal bleeding 5.27%

Facility Fee Sample

50010   Exploration of kidney -5.54%
50205   Remove vagina lesion 1.17%
50370   Destroy vag lesions simple 2.77%
50547   Remove vagina lesion 1.53%
50606   Endoluminal bx urtr rnl plvs -8.59%
51841   Destroy vulva lesions sim 3.07%
53210   I & d of vulva/perineum 2.69%
56805   Insert temp bladder cath 1.89%
57260   Lysis of labial lesion(s) 2.06%
57270   Biopsy of vagina 2.95%
57282   Treat vaginal bleeding 1.99%
57283   Drainage of gland abscess 2.89%
57284   Destroy vulva lesion/s compl 1.42%
57285   Destroy vag lesions complex 1.00%
57330   Insert bladder catheter 1.86%
57335   Remove vagina tissue part 1.00%
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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.