CMS Releases Medicare PFS Final Rule, CMS Reweights MIPS Categories

Publication Date: Nov 5, 2021

On Nov. 2, the Centers for Medicare and Medicaid Services (CMS) released its Medicare Physician Fee Schedule (PFS) Final Rule for CY 2022, which outlines its Medicare payment and policy changes for CY 2022. Importantly, CMS has agreed to adopt ASCP's recommendation to reweight the Quality and Improvement Activity scores.

The final rule’s impact table estimates an impact on pathologists of -1 percent and -2 percent for clinical laboratories. However, this impact does not take into account a 3.75-percent reduction in the Medicare conversion factor due to the expiration of a statutory increase specific to CY 2021. As a result, the estimated reduction in overall charges attributable to the proposed rule would be approximately 5 percent for pathologists and 6 percent for clinical laboratories.

New Pathology-Specific Policy Changes
New for 2022 is the adoption of a new series of pathology consult codes, 80XX0-80XX3, which describe consultation services provided upon request by another physician or health care provider. These new codes replace CPT codes 80500 & 80502. In adopting these codes, ASCP and the pathology community were able to persuade CMS to increase payment rates for these codes to account for certain costs but the Agency did not agree to all of ASCP’s reimbursement recommendations for these codes.

Clinical Labor Pricing Updates
As part of this year’s proposed rule, CMS finalized a proposal to update its clinical labor prices for the first time since 2002, and will generally follow the Bureau of Labor Statistics for valuing these services. These rates are used for identifying the wage costs of services provided by laboratory professionals and other non-physician healthcare providers. ASCP supported the Agency’s recommendations as the most relevant data source available to value all personnel groups identified in the rule. In the rule, CMS finalized wage rates for cytotechnologists, histotechnologists, and others.

Laboratory Specimen Travel Logs/Collection Fees/Travel Allowances
In comments on the proposed rule, ASCP urged CMS to allow on a permanent basis the use of electronic travel logs. CMS will be finalizing ASCP’s recommendation for all laboratory specimen collections (not just COVID-19 testing). Moreover, CMS announced in July that it proposed to discontinue the higher laboratory specimen collection fees for COVID-19 tests when the public health emergency (PHE) ends. In response, ASCP urged the Agency to continue paying these higher payment rates for laboratory staff traveling to secure patient specimens, arguing that the COVID-19 pandemic is ongoing and the expectations that the disease will become endemic warrants maintaining these rates at least for the foreseeable future. CMS is not finalizing cuts in specimen collection fees at this time.

Quality Payment Program (QPP)
In comments submitted on the proposed rule, ASCP advocated for increased flexibilities and a reduction in reporting burden for pathologists. For the 2022 reporting year, CMS finalized a proposal that would require the majority of pathologists to participate in the QPP through either Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Additionally, CMS finalized their plan to begin a gradual implementation of MIPS Value Pathways (MVPs) beginning with the 2023 performance period. ASCP urged CMS to work with specialty societies and other stakeholders in the development of MVPs, and we are hopeful for the opportunity to help the Agency develop a pathology-specific MVP to allow for meaningful participation for pathologists.

ASCP is pleased CMS has agreed to ASCP’s request to reweight the Quality and Improvement Activity scores reweighted. Beginning in 2022, that Quality and Improvement Activities will each be worth 50% of their MIPS score. Previously, pathologists in small practices who were exempt from the Promoting Interoperability and Cost categories had their Quality scores reweighted to 85% and their Improvement Activity scores reweighted to 15%. With the Improvement Activities category is easier for pathologists to attest to and with activities that are more meaningful to pathologists, this change should help small pathology practices. Moreover, the quality category has only 6 pathology measures and in the pathology quality measures set, which are mostly topped out and don't drive real improvement or quality.

CMS also finalized a new ASCP-supported improvement activity in support of the implementation of a laboratory preparedness plan to target current and future public health emergencies. The Pathology Specialty Measure Set will consist of the same six quality measures in 2022 as in 2021.

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

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