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.
- 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.
- 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.
- 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.
- The Radiation Oncology and Radiation Therapy Centers demonstration project was delayed until 2023.
- 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
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
|CODE||MODIFIER||DESCRIPTION||PERCENT FEE CHANGE OFFICE|
|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%|
|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%|
|55874||Tprnl plmt biodegrdabl matrl||-5.67%|
|57465||Cam cervix uteri drg colp||-4.41%|
Office fees Increasing -Sample
|CODE||MODIFIER||DESCRIPTION||PERCENT FEE CHANGE OFFICE|
|50430||Njx px nfrosgrm &/urtrgrm||3.61%|
|50431||Njx px nfrosgrm &/urtrgrm||8.53%|
|50690||Injection for ureter x-ray||4.44%|
|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%|
|52310||Cystoscopy and treatment||3.60%|
|53620||Dilate urethra stricture||5.95%|
|53621||Dilate urethra stricture||6.31%|
|53860||Transurethral rf treatment||3.52%|
|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
|CODE||MODIFIER||DESCRIPTION||PERCENT FEE CHANGE ASC/HOPD|
|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%|