Radiology Reimbursement: Good News and Bad News

There is good news and bad news for radiology in proposed changes for 2022 reimbursement.

Good news

The proposed Medicare Physician Fee Schedule (MPFS) for 2022 delays implementation of Appropriate Use Criteria (AUC) until 2023.
Congress is pressuring CMS to reconsider AUC completely.
CMS is dropping certain coverage restrictions around PET imaging outside of oncology, a move providers are calling “significant” for the field.
Bipartisan bills introduced in both chambers of Congress would preserve payment for mammography screenings before age 50.

Bad news

The proposed Medicare Physician Fee Schedule (MPFS) for 2022 estimates a CY 2022 conversion factor of $33.5848 compared to 2021 at $34.8931.
CMS estimates an overall impact on radiology to be a 2 percent decrease, with interventional radiology seeing a decrease of 9 percent, nuclear medicine a 2 percent decrease and radiation oncology and radiation therapy centers a 5 percent decrease.
The American College of Radiology, the AMA and others are lobbying Congress to offset the 2022 decreases.
If the pause in the two-percent sequestration cut is allowed to expire, as planned, on December 31, 2021, these decreases will be larger, unless Congress intervenes.
Late in 2021, Congress included a 3.75 percent adjustment to the 2021 conversion factor which rolled back the payment cuts to radiologists from 10 percent to approximately 4 percent. While Congressional action is possible for 2022, that uncertainty will remain until late this year.

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