Medicare Administrative Contractor Posts Fee Schedule

On Nov. 2, 2021, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that includes Medicare Part B payment and policy updates under the Physician Fee Schedule (PFS) that are effective on and after Jan. 1, 2022. Services paid under the PFS are furnished in a variety of settings, including skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes.

While the payment rates are based on individual Healthcare Common Procedure Coding System (HCPCS) codes and comprised of several components, the conversion factor is a key feature that is updated annually and impacts all rates. Given budget neutrality requirements and the expiration of the 3.75 percent temporary payment increase in Calendar Year (CY) 2021 provided by the Consolidated Appropriations Act, 2021 (CAA), the conversion factor for CY 2022 will be $33.59, a decrease of $1.30 from the current CY.

In 2022, CMS is also completing the implementation of Bipartisan Budget Act of 2018 provisions that require CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85 percent of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) when they are appropriately supervised by a physical therapist (PT) or occupational therapist (OT), respectively, for dates of service on and after Jan. 1, 2022.

Rates for Part B services are listed on the PFS by HCPCS code. National Government Services (NGS), the Medicare Administrative Contractor (MAC) for New York State, has added the 2022 rates to the PFS look-up tool available on its website (select “Resources,” then “Tools and Calculators,” then “Fee Schedules”). CMS also offers a look-up tool (not yet updated with 2022 rates) along with a helpful guide that may also help the user understand the Medicare Part B rate structure.

The rates are regional, with New York divided into five regions:

Region 1: Manhattan

Region 2: Bronx, Brooklyn, Nassau, Rockland, Staten Island, Suffolk, Westchester

Region 3: Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, Ulster

Region 4: Queens

Region 99: Albany, Oneida, Allegany, Onondaga, Broome, Ontario, Cattaraugus, Orleans, Cayuga, Oswego, Chautauqua, Otsego, Chemung, Rensselaer, Chenango, Saratoga, Clinton, Schenectady, Cortland, Schoharie, Erie, Schuyler, Essex, Seneca, Franklin, Steuben, Fulton, St. Lawrence, Genesee, Tioga, Hamilton, Tompkins, Herkimer, Warren, Jefferson, Washington, Lewis, Wayne, Livingston, Wyoming, Madison, Yates, Monroe, Montgomery, Niagara

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841