2022 Medicare Part B Schedule

Attached is the 2022 Medicare Part B fee schedule, effective 1/1/22 through 12/31/22. To identify the fee amount for your facility, please locate the appropriate CPT/HCPCS code and match it to the respective facility location column.

As a reminder, the Medicare Part B outpatient therapy cap (KX Modifier) amounts are updated and are $2,150 for occupational therapy, and $2,150 for physical therapy and speech therapy services combined for CY 2022. The targeted medical review process, now-termed Medical Review threshold, amount is $3,000 for PT and SLP services combined and $3,000 for OT services. The Final Rule also reminds providers that the application of therapy caps and therapy caps exception process was repealed effective 1/1/18. Note the 15% payment reduction (highlighted below) for PT/OT services performed by a PTA/OTA.

Please refer to the AHCA bulletin below, which provides details of the methodology, as well as related CMS links.

Recently, the Centers for Medicare and Medicaid Services (CMS) posted rate files for the calendar year (CY) 2022 Medicare Part B Physician Fee Schedule (PFS). These files reflect temporary provider relief provisions included in the Protecting Medicare and American Farmers from Sequester Cuts Act (Pub. L. 117-71) signed into law on December 10, 2021.

While each Medicare Administrative Contractor (MAC) is required to post rate tables applicable to their geographic coverage areas, AHCA/NCAL has incorporated these tables into a reference Microsoft Excel​ CY 2022 outpatient therapy fees file for members. The AHCA/NCAL tables provide geographic-adjusted rates for Medicare Part B physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services billed under the PFS.

Thanks to Tony Marshall, President and CEO of the Georgia Health Care Association and Georgia Center for Assisted Living for developing the AHCA/NCAL rate tables for members.

AHCA/NCAL Rate Tables Details 

The 2022 therapy fees for each CPT/HCPCS Code in each geographic area are provided in the attached Excel file. The file contains the following information:

1. The 2022 Medicare Part B Fee Schedule for Outpatient Rehabilitation for each Carrier and Locality (Part B Fees)  
2. The 2022 Medicare Part B MPPR Fee Schedule for “Always Therapy Services (50% MPPR Factor) for each Carrier and Locality (MPPR Fees)  
3. The 2022 Relative Value Units for each Outpatient Rehabilitation Therapy Code (RVUs)  
4. The 2022 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)  
5. The Counties Included in 2022 Localities (GPCI Counties)  

The Part B Fee Schedule amounts are calculated as follows:

((A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and

((A1 x B1) + ((A2 x B2) x (1-MPPR Factor) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where:

A1 = Physician Work RVU

A2 = Non-Facility Practice Expense RVU

A3 = Malpractice RVU

B1 = Work GPCI

B2 = Practice Expense GPCI

B3 = Malpractice GPCI

Conversion Factor = $34.6062

MPPR Factor = 50%

Due to the unique application of the new therapy assistant adjustment policy as described below, the AHCA/NCAL therapy fees tables do not include therapy assistant adjustment policy rate tables. 

Beginning in CY 2022, section 1834(v)(1) of the Act requires that CMS applies a 15 percent payment reduction for outpatient occupational therapy services and outpatient physical therapy services that are provided, in whole or in part, by a physical therapist assistant (PTA) or occupational therapy assistant (OTA). Section 1834(v)(2)(A) of the Act required CMS to establish modifiers to identify these services, which were promulgated in the CY 2019 PFS final rule (83 FR 59654 through 59661), creating the CQ and CO payment modifiers for services provided in whole or in part by PTAs and OTAs, respectively.  

These payment modifiers were required to be used on claims for services with dates of service beginning January 1, 2020, as specified in the CY 2020 PFS final rule (84 FR 62702 through 62708). CMS will now apply the 15 percent payment reduction to therapy services provided by PTAs (using the CQ modifier) or OTAs (using the CO modifier) beginning with dates of service on or after January 1, 2022, as required by statute.  Additional revisions and clarifications to the policy were detailed in the CY 2022 PFS Final Rule (86 FR 65011, 65169-65177) and which were summarized in MLN Matters Article MM12519.

Under sections 1834(k) and 1848 of the Act, payment is made for outpatient therapy services at 80 percent of the lesser of the actual charge or applicable fee schedule amount (the allowed charge). The remaining 20 percent is the beneficiary copayment. For therapy services to which the new discount applies, payment will be made at 85 percent of the 80 percent of allowed charges. Therefore, the volume discount factor for therapy services to which the CQ and CO modifiers apply is: (0.20 + (0.80* 0.85), which equals 88 percent.

Additional Background  

The fees effective January 1, 2022, are calculated based upon the CY 2022 Payment Policies Under the Physician Fee Schedule (PFS) and Other Changes to Part B Payment Policies Final Rule (CMS-1751-F) (Transmittal 11146/Change Request 12519) (MLN Matters article MM12519) published in the Federal Register on November 19, 2021. This major final rule revises payment polices under the Medicare PFS and makes other policy changes, including the implementation of certain provisions of the Bipartisan Budget Act of 2018 (BBA of 2018) (Pub. L. 115–123, February 9, 2018). Further, the Consolidated Appropriations Act, 2021 (CAA 2021) (Pub. L. 116-260, December 27, 2020) modified the FY 2022 MPFS reinstating the Work GPCI floor through CY 2023. Additionally, as required by the ACA, the 1.5 work GPCI floor for Alaska and the 1.0 practice expense GPCI floor for frontier states are permanent, and therefore, applicable in CY 2022.

Per the PFS final rule, the CY 2022 PFS conversion factor was $33.5983 after applying the -0.10 percent Budget Neutrality adjustment under section 1848(c)(2)(B)(ii)(II) of the Act, the 0.00 percent update adjustment factor specified under section 1848(d)(19) of the Act, and the expiration of the 3.75 percent increase for services furnished in CY 2021, as provided in the CCA 2021. However, the final CY 2022 conversion factor is $34.6062 following application of the payment increases provided by the Protecting Medicare and American Farmers from Sequester Cuts Act (Pub. L. 117-71) signed into law on December 10, 2021.

The final rule continues the multiple procedure payment reduction (MPPR) policy for “always therapy” services. The MPPR policy required, effective April 1, 2013, a 50 percent reduction to be applied to the practice expense component of payment for the second and subsequent “always therapy” service(s) that are furnished to a single patient by a single provider on one date of service (including services furnished in different sessions or in different therapy disciplines). The MPPR worksheet lists those “always therapy” services subject to the MPPR policy and the reduced fee payment amounts.

Transmittal 11118/Change Request 12446 and MLN Matters article MM12446 updates the therapy code list and associated policies for CY 2022. Codes for Remote Therapeutic Monitoring/Treatment Management (RTM CPT codes 98975, 98976, 98977, 98980, and 98981) services were designated as “sometimes therapy” to permit physicians and certain Nonphysician Practitioners (NPPs), including nurse practitioners, physician assistants, and clinical nurse specialists to furnish these services outside a therapy plan of care when appropriate. When furnished by therapists, these “sometimes therapy” services are “always therapy,” which means they must be accompanied by the appropriate therapy modifier (GP, GO or GN) to reflect that it is under a physical therapy, occupational therapy, or speech-language pathology plan of care, respectively.

The HCPCS CPT codes and short descriptors:

​

The CTB CPT codes for telephone assessment services (98966, 98967, and 98968) added via CR 11791 as “sometimes therapy” codes remain effective for the duration of the PHE for COVID-19.

Further, please see the 2022 Part A MAC Update to download the 2022 Annual SNF Consolidated Billing HCPCS Updates that include the Major Category V Part B Therapy Inclusions.

Effective for January 1, 2018, Section 50202 of the BBA of 2018 repealed the application of the therapy caps and the therapy caps exceptions process while also retaining and adding limitations to ensure appropriate therapy. A separate provision of Section 50202 of the BBA of 2018 preserves the former therapy cap amounts as thresholds above which claims must include the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. Claims for therapy services above these amounts without the KX modifier are denied. These amounts are now known as the KX modifier thresholds and are a permanent provision of the statute, meaning that the statute does not specify an end date. Just as with the incurred expenses for the therapy cap amounts, there is one KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined and a separate amount for occupational therapy (OT) services. The per beneficiary amounts are updated each year based on the Medicare Economic Index (MEI). For CY 2022, the KX modifier threshold amounts are: (a) $2,150 for PT and SLP services combined, and (b) $2,150 for OT services. The targeted medical review process, now-termed Medical Review threshold, amount remains at $3,000 for PT and SLP services combined and $3,000 for OT services until CY 2028. Please see the MPFS Final Rule (page 65177 of the Federal Register), Transmittal 11146/Change Request 12519, and MLN Matters article MM12519 for information on the KX modifier thresholds.

Please contact Dan Ciolek if you have any questions. Resource links may be found below.

Resources:

1. Physician Fee Schedule Payment Policies 
2. CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies Final Rule (CMS-1751-F) – December 19, 2021 Federal Register  
3. Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule – Transmittal 11146/Change Request 12519 
4. Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule MLN Matters Article – MM12519
5. Summary of Key Provisions in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule (Newsroom)  
6. Therapy Services Overview 
7. 2022 Therapy Services Code List (Annual Therapy Update) 
8. 2022 Annual Update to the Therapy Code List – Transmittal 11118/Change Request 12446​​
9. 2022 Annual Update to the Therapy Code List MLN Matters Article – MM12446 
10. Skilled Nursing Facility Consolidated Billing and Annual Updates  
11. 2022 Part A MAC Update (2022 Annual SNF Consolidated Billing HCPCS Updates) – Major Category V Part B Therapy Inclusions  
12. 2021 Annual Update of Per-Beneficiary Threshold Amounts – Transmittal 10464/Change Request 12014  
13. 2021 Annual Update of Per-Beneficiary Threshold Amounts MLN Matters Article – MM12014​
14. March 1, 2020 Therapy Codes Update – Transmittal 10161/Change Request 11791 
15. March 1, 2020 Therapy Codes Update MLN Matters Article – MM11791
16. Protecting Medicare and American Farmers from Sequester Cuts Act (Pub. L. 117-71)
17. Bipartisan Budget Act of 2018 (Pub. L. 115–123, February 9, 2018)
18. Consolidated Appropriations Act, 2021 (Pub. L. 116-260, December 27, 2020) 

NYSHFA/NYSCAL CONTACTS:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36