Rehab Industry Changes for 2022

By: Cheryl “Chae” Dimapasoc Canon, PT, DPT; OptimisPT Director of Implementation and Compliance

January 1, 2022 is almost here, so we wanted to make sure that you are aware of any changes that may need your attention in the rehab world. We’ve pulled together information regarding some of the more important changes occurring in the new year. For our OptimisPT clients, all information has been updated in OptimisPT accordingly, including MIPS preferences for those practices that have responded to the MIPS 2022 survey via the survey or support ticket. If you haven’t submitted your practice’s MIPS 2022 reporting preference, you may still do so at this time.

Final Changes to the Medicare Physician Fee Schedule for Calendar Year 2022

(Changes automatic in OptimisPT)

Conversion factor: CY 2022 PFS conversion factor is $33.5983, a decrease of $1.30 from the CY 2021 PFS conversion factor of $34.89.

2022 Medicare $ Amount for the threshold thermometer: $2,150

Targeted Medical Review begins at $3,000.

As of 12/10/2021, additional legislation was passed in Congress that combines additional funding and provides delays to planned cuts for 2022. The bill was first passed by the House of Representatives on Dec. 7, with its companion bill approved in a 59-35 bipartisan vote in the U.S. Senate on Dec. 9. The bill sets out three major (but temporary) relief provisions:

CMS will receive a 3% appropriation for 2022 to partially offset its planned 3.75% cut to the conversion factor used to set payment for codes used by providers.
Implementation of a looming 4% across the board “pay as you go” cut mandated through budget rules will be postponed until 2023.
A temporary moratorium on the 2% Medicare sequestration cut required by law since 2011 as part of a deficit spending mechanism will be continued through part of 2022. The moratorium will last until April, when a 1% sequestration will return, with the full 2% sequestration reduction beginning in July. Given that sequestration cuts are baked into the Medicare system, the temporary reprieve has amounted to a small payment increase for providers since the moratorium was put in place in 2020.

CQ/CO Modifier 2022

CO / CQ 15% reduction will come into effect on January 1, 2022. The unit will now be configured on de minimis and is not applied until more than mid-point, 8 minutes vs 2 minutes previously. This calculation will be applied per CPT code (not total time.)

Specifically, CMS’ revised policy would allow a 15-minute timed service to be billed without the CQ/CO modifier in cases when a PTA/OTA participates in providing care to a patient, independent from the PT/OT, but the PT/OT meets the Medicare billing requirements for the timed service on their own, without the minutes furnished by the PTA/OTA, by providing more than the 15-minute midpoint (that is, 8 minutes or more ─ also known as the 8-minute rule). Under this finalized policy, any minutes that the PTA/OTA furnishes in these scenarios would not matter for purposes of applying a modifier when billing Medicare.

In addition to cases where one unit of a multi-unit therapy service remains to be billed, CMS revised the de minimis policy that would apply in a limited number of cases where there are two 15-minute units of therapy remaining to be billed. For these limited cases, CMS is allowing one 15-minute unit to be billed with the CQ/CO modifier and one 15-minute unit to be billed without the CQ/CO modifier in billing scenarios where there are two 15-minute units left to bill when the PT/OT and the PTA/OTA each provide between 9 and 14 minutes of the same service when the total time is at least 23 minutes and no more than 28 minutes.

Overall, the de minimis standard would continue to be applicable in the following scenarios:

When the PTA/OTA independently furnishes a service, or a 15-minute unit of a service “in whole” without the PT/OT furnishing any part of the same service.
In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy.
When the PTA/OTA furnishes 8 minutes or more of the final 15-minute unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service.
When both the PTA/OTA and the PT/OT each furnish less than 8 minutes for the final 15-minute unit of a billing scenario (the 10 percent standard applies).

As an OptimisPT client, these calculations are automatically done for you and the modifier is applied when necessary.

The PTA/COTA Payment Differential

As expected, CMS is also moving ahead with the implementation of a 15% payment reduction for services furnished by a PTA or OTA, a change that it says was required by law through the 2018 Bipartisan Budget Act. Barring congressional intervention, beginning Jan. 1, 2022, Medicare will pay for services furnished “in whole or in part” by a PTA or OTA at 85% of the code value.

The 15% is applied to only the 80% paid by Medicare, not the total billed amount. Therapy clinics should calculate bills including MPPR, and then charge the patient the 20% copay based on that total. The remaining 80% paid directly by CMS will be reduced by 15% when the services are appended with the CQ modifier. The acknowledgement in the final rule means that, in real dollars, the differential cut is closer to a 12% reduction.

Good News on Remote Therapeutic Monitoring Codes

CMS had originally indicated that PTs and PTAs would not be able to bill these codes. Now, beginning Jan. 1, 2022, physical therapists and physical therapist assistants will be permitted to bill all five of these codes!

What are the Remote Therapeutic Monitoring Codes?

The RTM family includes three practice expense (PE)-only codes and two codes that include professional work. The new RTM codes are:

CPT 98975

Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment

CPT 98976

Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g. daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

CPT 98977

CPT 98980

Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

CPT 98981

Telehealth

PTs, OTs and SLPs will continue to be able to bill for services delivered through telehealth for as long as the public health emergency is in place. Once the emergency is ended, however, they will no longer be considered eligible providers of telehealth.

The information provided is meant to be an overview of the changes occurring secondary to the finalized 2022 Medicare Physician Fee Schedule. This is not an all inclusive list, however, it should serve as a good reference reflecting the most important changes for the rehab industry. For 2022 MIPS changes please reference our previous blog “MIPS Changes for 2022”.