CMS 2022 Physician Fee Schedule includes payment cut

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AAO, Surgical Care Coalition teaming up to ensure the final version of the rule is fair to ophthalmologists and surgeons as one company is expressing its disappointment in the proposal.

The proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program rules released by Centers for Medicare and Medicaid Services (CMS) may usher in a wide range of changes, including a 3.75% reduction in the conversion factor used to calculate payments to physicians.

However, according to the Surgical Care Coalition, the proposal by CMS fails to address pending cuts to surgical care and therefore continues to threaten patient care by reaffirming these previously imposed cuts.

The cuts are the result of a reduction that is necessary to keep Medicare payments budget neutral. At the end of 2020, Congress passed a one-year fix that prevented the cuts due to take effect in 2021. Without additional intervention, the cuts will go into effect Jan. 1, 2022.

CMS is proposing to cut the Medicare conversion factor—the basic starting point for calculating Medicare payments—for CY2022 by 3.75%. This year's cut is reinstating the cut that Congress prevented last year, which further emphasizes the need for continued congressional intervention to protect patient care.

The Surgical Care Coalition noted that updates to the conversion factor have failed to keep up with inflation, and it will be joined by the American Academy of Ophthalmology to ensure the final version of the rule is fair to ophthalmologists and surgeons. 

"CMS' proposed 2022 Medicare Fee Schedule has a huge effect on ophthalmology's ability to run a successful ophthalmology practice, which has one of the highest Medicare beneficiary bases," said George A. Williams, MD, AAO Senior Secretary for Advocacy. "The academy is proud to partner with the Surgical Care Coalition and will work over the next few months in an effort to ensure that the final version of the rule is fair to ophthalmologists and surgeons."

The proposal’s release is followed by a 60-day public comment period closing on Sept. 13, which will culminate in CMS' release of the final rule, which is expected to be announced by November for implementation on Jan. 1, 2022. As a result, the proposed rule could be subject to change before a funal rule is released.

Glaukos Corp. has stepped up to discuss the proposal, noting that the proposed rule and accompanying addenda include payment rates for two new Category I Current Procedural Terminology (CPT) codes, including 669X2 for non-complex cataract extraction in combination with the insertion of an aqueous drainage device and 669X1 for complex cataract extraction in combination with the insertion of an aqueous drainage device.

Category I CPT Codes 669X2 and 669X1 will replace Category III codes 0191T and 0376T as the primary codes that physicians will use to seek reimbursement utilizing Glaukos’ trabecular micro-bypass technologies (iStent, iStent inject, iStent inject W) when used as approved in combination with cataract surgery.

Applying the CMS 2022 Proposed Rule’s assigned total facility Relative Value Units (RVUs) and associated conversion factor, Glaukos estimated a proposed 2022 physician fee for Category I CPT Code 669X2 of approximately $565.23, representing incremental physician fee payment for the insertion of an aqueous draining device of approximately $34.25 versus the proposed 2022 physician fee of approximately $530.98 for Category I CPT Code 66984 (non-complex cataract surgery alone).

“We are aware of and extremely disappointed with CMS’ proposed 2022 physician fees for the new Category I codes that cover our sight-saving trabecular micro-bypass technologies used in combination with cataract surgery,” said Thomas Burns, Glaukos’ president and CEO. “While this is unwelcomed and unexpected news that we believe is unjustified, we are eager to engage with our key ophthalmic societies and are committed to exploring every option during the public comment period in hopes that medical providers across our network are paid appropriately for conducting these types of procedures.”

This announcement does not include the Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule for Calendar Year 2022, which will include proposed facility fee payments for services furnished in both the hospital outpatient department (HOPD) and ambulatory surgical center (ASC) settings. Glaukos expects the 2022 Medicare OPPS Proposed Rule to be released by CMS over the coming days to weeks.

David B. Hoyt, MD, FACS, executive director of the American College of Surgeons, noted that while CMS is taking notable strides to improve health equity and access to care, the proposed rule maintains the cuts to surgical care that Congress stopped last year.

“These cuts harm the care patients need and deserve, which is the opposite of what CMS is trying to achieve," he said. "Without congressional action, surgical care faces a significant payment cut and threatens patient access to critical treatments and procedures. All patients deserve a health care system that invests in surgical care and does not create uncertainty year after year."