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CMS issues 2022 pricing updates poised to reduce radiology reimbursement

por John R. Fischer, Senior Reporter | November 04, 2021
Business Affairs Rad Oncology
CMS has issued the 2022 MPFS and HOPPS-ASC final rules
Despite objections from physician groups, the Centers for Medicare and Medicaid Services is moving ahead with clinical labor pricing updates that are expected to reduce reimbursement for a number of specialties, including radiology and radiation oncology.

The updates are included in the 2022 Medicare Physician Fee Schedule (MPFS) final rule, which was released this week by CMS, and are part of a proposal to increase wages for clinical labor staff.

As such expenses are budget neutral, an increase in them means a proportional decrease in areas such as medical supplies and equipment costs. As a result, specialties such as interventional radiology and radiation oncology are expected to bear the brunt of these decreases, said the American Society of Radiation Oncology in a statement. “These cuts will endanger patient access to cancer care. Treatment facilities may be forced to cut services or close, which will exacerbate health disparities."

In addition, a temporary pandemic-related pay bump of 3.75% is due to expire, cutting the conversion factor from $34.89 to $33.59. “If Congress does not intervene, the percent decreases mentioned above could be greater for CY 2022 for many physicians including radiology,” said the American College of Radiology.

These updates will be phased in over a four-year period, but modifications made by CMS will reduce the initial expected impact to radiology from 2% to 1%, 2% to 1% for nuclear medicine, 9% to 5% for interventional radiology and 5% to 1% for radiation oncology and radiation therapy centers, according to ACR.

ACR applauded CMS for postponing the penalty phase for the Appropriate Use Criteria program by one year, to January 1, 2023. This proposal will require physicians to filter their recommendations through a decision-support system before ordering advanced imaging to reduce unnecessary exams. In addition, CMS has increased the conversion factor by 2%, which brings it up to $84.177 for 2022. In doing so, urban hospitals can expect to see payment increases of approximately 2.1%, and for rural hospitals, 2.3% increases.

Along with the 2022 MPFS final rule, CMS published another ruling this week, the 2022 Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) final rule. Under this policy, reimbursement for lung cancer screenings will increase by 37.44%, from $80.90 to $111.19. "New U.S. Preventive Services Task Force guidelines have nearly doubled the number of people eligible for such screening. However, less than 15% of Americans who met previous USPSTF lung cancer screening criteria are tested. Improved payment may bolster lung cancer screening availability,” said ACR.

And reimbursement for medical physics dose evaluation for radiation exposure that exceeds institutional review threshold will rise from $130.19 to $345.85.

Radiology groups welcomed CMS’ decision to cover 30% of all radiation oncology "episodes”. To do this, it would pay participating providers and suppliers a site-neutral, episode-based payment for specified professional and technical RT services furnished during a 90-day episode to Medicare fee-for-service beneficiaries diagnosed with certain types of cancer.

While reassuring, ASTRO says the planned, mandatory starting date of January 1, 2022 for radiation oncology facilities to participate in the RO Model is “extremely challenging,” and says it plans to work with CMS to improve quality without forcing onerous reporting requirements on radiation oncology practices. “ASTRO appreciates the more-than 100 members of Congress who wrote CMS opposing these cuts, and we intend to work with these radiation oncology congressional champions on a legislative solution to address the Medicare cuts before the year ends.”

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