Final Medicare Physician Billing Rates for 2022

Medicare physician billing rates for 2022 are now finalized with Congress over ruling most of the 9.75% cut proposed by CMS. See “Physician Billing in 2022: 10% Medicare Cut” for the CMS proposal.

In addition, the CMS radiation oncology model and large cuts to the clinical lab fee schedule were postponed by one year (see below).

Congress Overrules CMS Medicare Cuts 

The “Protecting Medicare and American Farmers from Sequester Cuts Act,” passed by Congress last week and just signed by the President, does the following

  • Postpones the 4% “PayGo” cut for one year.
  • Reinstates 3% of the Covid-driven 3.75% rate increase.
  • Delays the 2% sequester cut until July, with a 1% cut in the second quarter.

As a result, the headline 9.75% cut in the CMS proposal is now reduced to 2% spread unevenly across 2022

  • A .75% cut in the first quarter.
  • A 1.75% cut in the second quarter.
  • A 2.75% cut in the second half of the year.

Of course, these macro adjustments do not reflect specialty specific Medicare fee schedule adjustments. As an example, RBMA estimates the cuts  will now be about 3% for diagnostic radiology, and higher for interventional radiology.

While medical associations all cheered the legislation, they also pointed out the need for reform of Medicare rates to avoid the annual need for Congressional action. For example, Howard Fleishon, chair of ACR’s Board of Chancellors, said in a statement, “… we must begin to look beyond these short-term fixes. The ACR looks forward to working with Congress to address the ongoing structural problems associated with Medicare’s broken payment system.”

The American Medical Association (AMA) and others issued similar statements. “There is no need to wait for the last minute to start working on the systemic problems,” said AMA president Gerald Harmon, MD.” These automatic cuts should remind members of the needed reforms. Congress can get a head start on doing the right thing when it reconvenes early next year.”

CMS Radiation Oncology Model Delayed

The CMS Radiation Oncology (RO) project is intended to make site-neutral payments for certain radiation services. That model had already been delayed by a year and is now postponed until January 2023. The CMS RO model reduces reimbursement through bundling radiation therapy payments rather than paying for individual treatment episodes.

Oncology groups have warned that the mandatory model will lead to harmful cuts to radiation oncologists. 

Clinical Lab Rate Cuts Postponed

Proposed payment cuts to the Clinical Laboratory Fee Schedule (CLFS) were postponed by one year, much as they were for 2021. A group of 22 lawmakers had recently written to House leadership pushing for a delay to the cuts, which were required under budget neutrality rules..

The American Clinical Laboratory Association (ACLA) and another 27 health organizations recently sent a letter to congressional leaders saying that the “harmful” cuts — 15% for some 600 common clinical lab tests and up to 23%— would negatively impact lab services that are “essential to the health and wellbeing” of millions of Americans who have chronic diseases, particularly seniors.

Final Medicare Physician Billing Rates for 2022 References