Radiology Reimbursement: Good News and Bad News
There is good news and bad news for radiology in proposed changes for 2022 reimbursement.
- The proposed Medicare Physician Fee Schedule (MPFS) for 2022 delays implementation of Appropriate Use Criteria (AUC) until 2023.
- Congress is pressuring CMS to reconsider AUC completely.
- CMS is dropping certain coverage restrictions around PET imaging outside of oncology, a move providers are calling “significant” for the field.
- Bipartisan bills introduced in both chambers of Congress would preserve payment for mammography screenings before age 50.
- The proposed Medicare Physician Fee Schedule (MPFS) for 2022 estimates a CY 2022 conversion factor of $33.5848 compared to 2021 at $34.8931.
- CMS estimates an overall impact on radiology to be a 2 percent decrease, with interventional radiology seeing a decrease of 9 percent, nuclear medicine a 2 percent decrease and radiation oncology and radiation therapy centers a 5 percent decrease.
- The American College of Radiology, the AMA and others are lobbying Congress to offset the 2022 decreases.
- If the pause in the two-percent sequestration cut is allowed to expire, as planned, on December 31, 2021, these decreases will be larger, unless Congress intervenes.
- Late in 2021, Congress included a 3.75 percent adjustment to the 2021 conversion factor which rolled back the payment cuts to radiologists from 10 percent to approximately 4 percent. While Congressional action is possible for 2022, that uncertainty will remain until late this year.