Another gut punch to the continued declining reimbursement for anesthesia. The Final Rule was released for the Calendar Year (CY) 2022, and the Medicare National Anesthesia Conversion Factor dropped 2.9%, from $21.56 to $20.93.
Outlined below are changes brought about by the CMS Final Rule that affect anesthesia, both good and bad.
Anesthesia in ASCs
You likely already heard about the back and forth regarding CMS’ removal of 298 surgical codes from the inpatient only list thereby allowing payment for certain procedures in an ASC setting. Two codes were excluded in the Final Rule which means they will continue to be paid in an ASC setting:
- 01486 – Anesthesia for open procedures on bones of lower leg, ankle, and foot; total ankle replacement
- 01638 – Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; total shoulder replacement
CMS added 295 of the 298 surgical codes back to the Inpatient Only list and below is a table of 13 ASA codes that will no longer be payable in an ASC setting effective January 1, 2022:
|ASA Code||Procedure Description|
|00192||Anesthesia for procedures on facial bones or skull; radical surgery|
|00474||Anesthesia for partial rib resection: radical procedures|
|00904||Anesthesia for radical perineal procedures|
|01140||Anesthesia for interpelviabdominal (hindquarter) amputation|
|01150||Anesthesia for radical procedures for tumor of pelvis|
|01212||Anesthesia for open procedures involving hip joint; hip disarticulation|
|01232||Anesthesia for open procedures involving upper two thirds of femur; amputation|
|01234||Anesthesia for open procedures involving upper two thirds of femur; radical resection|
|01274||Anesthesia for procedures involving arteries of upper leg, including bypass graft; femoral artery embolectomy|
|01404||Anesthesia for open or surgical arthroscopic procedures on knee joint; disarticulation at knee|
|01634||Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; shoulder disarticulation|
|01636||Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation|
|01756||Anesthesia for open or surgical arthroscopic procedures of the elbow; radical procedures|
CMS approved an increase in base units for CPT code 00537, cardiac electrophysiolgic procedures including radiofrequency ablation, from 7 base units to 10 base units effective January 1, 2022.
Percutaneous Image Guided Spinal Procedures
Effective January 1, 2022, CMS replaced:
- 01935 (5 Base Units): Anesthesia for percutaneous image guided procedures on the spine and spinal cord: diagnostic
- 01936 (5 Base Units): Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic
with the 6 new codes outlined in the table below:
|ASA Code||Procedure Description||Base Unit Value|
|01937||Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic||4|
|01938||Anesthesia for percutaneous image guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral||4|
|01939||Anesthesia for percutaneous image guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic||4|
|01940||Anesthesia for percutaneous image guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral||4|
|01941||Anesthesia for percutaneous image guided neuromodulation or intravertebral procedures||5|
|01942||Anesthesia for percutaneous image guided neuromodulation or intravertebral procedures||5|
For services rendered on or after January 1, 2022, the coinsurance amount paid for planned colorectal cancer screening tests that require additional related procedures shall be reduced over time as outlined below:
- CY2022: 20% Patient Coinsurance
- CYs 2023 through 2026: 15% Patient Coinsurance
- CYs 2027 through 2029: 10% Patient Coinsurance
- CY 2030: 0% Patient Coinsurance
Per CMS, the reduction over time of the Coinsurance percentage holds true regardless of the code billed for establishment of a diagnosis, for removal of tissue or other matter, or for another procedure that is furnished in connection with and within the same clinical encounter as the screening.
CMS developed a new method to report MIPS titled MIPS Value Pathways or MVPs. This will offer anesthesia practices a new reporting method for CY 2023. However, for the CY2022 reporting year, the composite scoring has changed, making it that more difficult for anesthesia practices to avoid a penalty. The table below demonstrates the changes in scoring by category. Stay tuned for our QPP/MIPS specific post in the coming weeks.
|Category||Score||Change from 2021|
|Improvement Activities||15%||No change|
|Promoting Interoperability||25%||No Change|
*See the CMS Fact Sheet here: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule
*For information regarding the Quality Payment Program: https://qpp.cms.gov/resources/resource-library
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