Business and Coding Essentials

Archived Actions

COVID-19 Public Health Emergency ending May 11,2023

On January 9, 2023, The Biden administration announced that the COVID-19 public health emergency, which has been in place since January 2020, is set to end on May 11. “The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1 and April 11, respectively. At present, the Administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date,” the Office of Management and Budget (OMB) said in a statement. For more information on what will be affected and not affected see the HHS fact sheet.

Congress provides limited relief to MPFS cuts CY 2023

On Dec. 29, 2022, President Biden signed H.R.2617, Consolidated Appropriations Act, 2023. Within H.R.2617, Consolidated Appropriations Act, 2023, there are several provisions that impact the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) final rule. The bill provides partial relief to the proposed 4.5% cut to the Medicare physician fee schedule (MPFS) conversion factor (CF) over the next two years but does not preclude cuts completely. The bill includes a 2.5% increase to the MPFS CF for 2023 and a 1.25% increase for 2024 and waives the 4% decrease for pay-as-you-go (PAYGO). However, this still results in a 2% physician pay cut to the MPFS for sequestration.

Summary of payment provisions:

4.5 % decrease in the MPFS CF will now be a 2% decrease due to the 2.5% increase approved for 2023 and the finalized
1.5 % decrease due to budget neutrality requirements) 1.25% increase to MPFS CF for 2024
PAYGO (pay-as-you-go) 4% decrease is waived for two years and set to begin in 2025
3.5% Advanced Alternative Payment Model (APM) incentive for 2024
Extension of telehealth policies through 2024
1% decrease for IR facility (hospital) reimbursement is still in place
4% decrease for IR non-facility (OBL) reimbursement is still in place

Estimated reimbursement reduction for Interventional Radiologists: facility (hospital) 3%-non-facility (OBL) 6%

While this is discouraging news, due to the tireless efforts of your SIR Economics and Government Affairs teams, this reduction in reimbursement is a marked improvement in the reimbursement cuts IR faced in the 2023 MPFS proposed rule (-11.5% for IRs in the facility setting; -14.5% for IRs in the non-facility setting). Below, SIR Economic Steering Committee provides a summary and a final impact analysis of IR codes for CY 2023.

SIR summary of H.R. 2617

SIR CY 2023 Final impact analysis IR codes

SIR MPFS Town Hall aired Dec. 8

SIR held a special town hall on Dec. 8 to discuss the effects of the 2023 Medicare Physician Fee Schedule (MPFS), which could result in significant reimbursement cuts for interventional radiologists. Learn how these changes will affect you, your practice, and your patients and how you can help fight back.

To view the recording, click here, and for handouts, click here.

MPFS CY 2023 final rule

On Nov. 1, 2022, CMS published the final CY 2023 Medicare physician fee schedule (MPFS) rule. Notably, the 2023 Medicare conversion factor will be reduced by 0%, but the 3% supplemental increase to PFS payments for CY 2022 has expired. The final CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.

The AMA and the Federation are “strongly advocating that Congress avert this payment cut, as well as implement an inflationary update for physicians, extend the 5 percent Advanced APM incentive and prevent the steep increase to the participation requirements for APMs, and waive the 4 percent PAYGO sequester.”

Due to SIR regulatory advocacy an Angio technician labor type has changed to a vascular interventional technologist. Additionally, SIR partnered with ASRT and submitted their radiologic technologist wage and salary survey from 2022. CMS now have specific wage data which will allow them to no longer rely on crosswalks for pricing and make use of direct BLS wage data for the occupation. CMS will update the pricing of a vascular interventional technologist from 0.60 to 0.84.

SIR economics steering committee reviewed the final rule and provides a summary and an impact analysis below.

SIR MPFS CY 2023 summary

SIR MPFS CY 2023 impact analysis

MPFS CY 2023 final rule

MPFS CY 2023 CMS fact sheet

HOPPS CY 2023 final rule

On Nov. 1, 2022 the final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2023 based on CMS's continuing experience with these systems. The Centers for Medicare & Medicaid Services (CMS) describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. Also, this final rule updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program; the ASC Quality Reporting (ASCQR) Program; and the Rural Emergency Hospital Quality Reporting (REH) Program. CMS also make updates to the requirements for Organ Acquisition, REHs, Prior Authorization, and Overall Hospital Quality Star Rating. CMS is establishing a new provider type for REHs, and we are finalizing proposals regarding payment policy, quality measures, and enrollment policy for REHs. In addition, CMS is finalizing the Conditions of Participation that REHs must meet in order to participate in the Medicare and Medicaid programs. This rule also finalizes changes to the Critical Access Hospitals (CAH) CoPs for the location and distance requirements, patient’s rights requirements, and flexibilities for CAHs that are part of a larger health system. Finally, CMS is finalizing, as implemented, a number of provisions included in the COVID-19 interim final rules with comment period (IFCs).

SIR economics steering committee provides a summary and impact analysis below.

SIR HOPPS CY 2023 summary

SIR HOPPS CY 2023 impact analysis

HOPPS CY 2023 final rule

HOPPS CMS fact sheet

SIR submits comment to the 2023 HOPPS proposed rule

On Sept 13, 2022, the Society of Interventional Radiology (SIR) submitted a comment letter to the proposed Hospital Prospective Payment System (HOPPS) rule for CY 2023. SIR commented on payment rate adjustments, complexity adjustment payments in ambulatory surgical centers, supervision by nonphysician practitioners (NPPs) of hospitals, diagnostic services furnished to outpatients in critical access hospitals, and transitional pass-through status for TriSalus Life Sciences® TriNav Infusion System and EVOKE® Spinal Cord Stimulation System.

SIR CY 2023 HOPPS comment letter

NCD for Percutaneous Transluminal Angioplasty (PTA)

On Feb 10, 2023 the Society of Interventional Radiology (SIR) submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) for the reconsideration of national coverage determination (NCD) 20.7 for percutaneous transluminal angioplasty (PTA) of the carotid artery concurrent with stenting.

Since the prior NCD, the SIR has monitored developments in the literature and additional outcomes have been published that support equipoise between CEA and CAS, thus supporting broader patient selection for CAS reimbursement. Based on this expanded body of clinical evidence, SIR supports updating NCD 20.7 to broaden Medicare beneficiary access to PTA and CAS.

Practice Expense Data Collection and Methodology

On Sept 6, 2022, SIR joined our allies to provide feedback to CMS regarding the design, sampling, and fielding of a potential future practice expense (PE) survey. The survey data could be used to estimate indirect practice costs and impact indirect PE valuation. Therefore, we ask that the Centers for Medicare and Medicaid Services (CMS) provide a clear roadmap with multiple opportunities for stakeholders to provide feedback on the data collection process, review the collected data, and consider whether it will be employed in future rate setting.

PE survey comment letter

HOPPS Facet Joint Interventions

On Sept. 13, 2022, the Society of Interventional Radiology (SIR) joined multiple societies asking The Center for Medicare and Medicaid Services (CMS) not to implement prior authorization requirements for facet joint interventions. Facet joint interventions are a crucial alternative to an opioid prescription for managing pain symptoms. We urge CMS to follow the recommendation of their Opioid Taskforce and allow for smooth access to facet joint interventions and other similar non-opioid treatments.

Facet joint interventions HOPPS letter

SIR submits comments to the 2023 MPFS proposed rule

On Sept. 1, 2022, the Society of Interventional Radiology (SIR) submitted a comment letter to the proposed 2023 Medicare physician fee schedule (MPFS) rule. SIR commented on the expiration of the 3% increase to the conversion factor (CF), 1.5 % budget neutrality decrease, 2% sequestration, and 4% pay-as-you-go (PAYGO) reductions proposed for 2023. In addition, SIR comments on the additional cut of 4% for the non-facility interventional radiology (IR) settings. If the Centers for Medicare and Medicaid Services (CMS) finalize these cuts, the estimated impact, according to the proposed rule, will be a 10.5% reduction in interventional radiology, and practices predominantly based in an office-based setting could see cuts as high as 14.5%.

If CMS is sincerely dedicated to closing the health equity gap, the agency should not implement the proposed cuts. As a result, this could limit patient access to critical IR services for essential procedures such as hemorrhagic and ischemic strokes, maternal health, PAD, dialysis access, radiation oncology, and pain management with a non-opioid alternative. In addition, IR practices will be negatively impacted and disincentivize providers from opening office-based labs in disadvantaged communities.

SIR commented on year 2 of the 4-year phase-in for clinical labor reductions proposed for Angio Technicians. SIR joined allies with the American Society of Radiologic Technologists (ASRT), which conducted a wage and salary survey of radiologic technology professionals every three years since 2001. SIR asks CMS to update the clinical labor description of an Angio Technician to Vascular Interventional Technologist to align with industry recognition of this advanced certification and increase the rate per minute to align with current industry salary data provided by ASRT.

SIR also commented on the following topics:

Indirect practice expense
Medicare economic index (MEI)
Malpractice RVUs
Geographic practice cost index (GPCI)
Proposed valuation of specific codes
Changes to evaluation and management (E/M) services for emergency department (ED) visits, inpatient and observation visits
Telehealth after the public health emergency (PHE)

Quality Provisions

MIPS value pathways (MVPs)
Quality measures
Qualified clinical data registry participation plan
Health inequities

SIR comment letter

IPPS final rule FY 2023

On Aug 1, 2022, the final rule for fiscal year (FY) 2023 for the inpatient prospective payment systems (IPPS) was released. The final rule will take effect on Oct 1, 2022. The complete rule can be accessed at the following link: https://public-inspection.federalregister.gov/2022-16472.pdf. The rule will revise the Medicare hospital IPPS for operating and capital-related costs of acute care hospitals. In addition, make changes relating to Medicare graduate medical education (GME) for teaching hospitals. Update the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs). SIR's economic steering committee provides a summary below.

SIR IPPS final rule summary

CMS IPPS final rule

CMS FY 2023 IPPS and LTCH PPS fact sheet

SIR seeks to have CMS update the salary wage of an Angio Technician

On Aug 1, 2022, SIR submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS). The letter is regarding CMS’s new policy that went into effect CY 2022, impacting Interventional Radiologist practicing in an office-based setting by reducing clinical labor reimbursement by -2% for CY 2022, with a four-year phase totaling -6% ending in CY 2025. In addition, SIR joined allies with the American Society of Radiologic Technologists (ASRT), which has conducted a wage and salary survey of radiologic technology professionals every three since 2001. SIR asks CMS to update the clinical labor description of an Angio Technician to Vascular Interventional Technologist to align with industry recognition of this advanced certification and increase the rate per minute to align with current industry salary data provided by ASRT.

SIR Clinical Labor update comment letter to CMS

HOPPS proposed rule CY 2023

On July 15, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 hospital prospective payment system (HOPPS) proposed rule. The complete rule can be accessed at the following link: CY 2023 hospital prospective payment system (HOPPS) proposed rule. The proposed changes are geared towards the following initiatives: changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the Ambulatory Surgical Center (ASC) Payment System. Also, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Rural Emergency Hospital Quality Reporting (REH) Program. CMS is also proposing updates to the requirements for Organ Acquisition, Rural Emergency Hospitals, Prior Authorization, and Overall Hospital Quality Star Rating. CMS has established a new provider type for rural emergency hospitals (REHs), and has proposals regarding payment policy, quality measures, and enrollment policy for REHs. Finally, CMS is soliciting comments on the use of CMS data to drive competition in healthcare marketplaces, and an alternative methodology for counting organs.

For 2023, CMS proposes to increase the payment rates under the OPPS by an Outpatient Department (OPD) fee schedule increase factor of 2.7 percent. This proposed increase factor is based on the proposed hospital inpatient market basket percentage increase of 3.1 percent for inpatient services paid under the hospital inpatient prospective payment system (IPPS) reduced by a proposed productivity adjustment of 0.4 percentage point. Based on this update, CMS estimates that total payments to OPPS providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix) for calendar year (CY) 2023 would be approximately $86.2 billion, an increase of approximately $6.2 billion compared to estimated CY 2022 OPPS payments.

CMS proposed to continue to implement the statutory 2.0 percentage point reduction in payments for hospitals that fail to meet the hospital outpatient quality reporting requirements by applying a reporting factor of 0.9805 to the OPPS payments and copayments for all applicable services.

Below, the SIR Economics Steering Committee provides a detailed summary and an IR impact analysis. SIR intends to provide formal feedback and comments to CMS regarding the proposed rule by Sept 13, 2022. When completed, the comment letter will be available to all SIR members.

SIR CY 2023 HOPPS proposed rule summary

SIR CY 2023 HOPPS impact analysis

CMS CY 2023 HOPPS proposed rule

CMS CY 2023 HOPPS/ASC proposed rule fact sheet

CMS CY 2023 HOPPS/ Rural Emergency Hospital fact sheet

MPFS proposed rule CY 2023

On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 Medicare Physician Fee Scheduled (MPFS) Proposed Rule. The complete rule can be accessed at the following link: https://public-inspection.federalregister.gov/2022-14562.pdf. The proposed changes are heavily geared towards the following initiatives:changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, the relative value of services, and changes in the statute; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; Medicare coverage of opioid use disorder services furnished by opioid treatment programs; updates to certain Medicare and Medicaid provider enrollment policies, including for skilled nursing facilities; updates to conditions of payment for DMEPOS suppliers; HCPCS Level II coding and payment for wound care management products; electronic prescribing for controlled substances for a covered Part D drug under a prescription drug plan or an MA-PD plan under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (SUPPORT Act); updates to the Medicare Ground Ambulance Data Collection System; and provisions under the Infrastructure Investment and Jobs Act.

Payment provisions

The proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the CY 2022 PFS conversion factor of $34.61. The reduction in the CF is due to the expiration of a 3% increase to the CF at the end of the calendar year 2022 and the budget neutrality decrease of 1.5%. If Congress does not intervene and extend the 3% increase, the percent decreases mentioned below will be greater for CY 2023.

Based on Table 138: CY 2023 PFS Estimated Impact on Total Allowed Charges by Specialty, IR is proposed to see a 4% decrease in reimbursement due to changes in relative value units (RVUs), this does not include the additional impact from decreases in the CF. RVU decreases are due to the second-year transition in clinical labor values specific to direct practice expense (PE) and malpractice RVU changes.

SIR's Economics Steering Committee thoroughly reviewed the proposed rule and provided a summary for members below. SIR intends to provide formal feedback and comments to CMS regarding the proposed rule by September 6, 2022. When completed, the comment letter will be available to all SIR members.

SIR CY 2023 MPFS proposed rule summary

SIR CY 2023 IR code impact analysis

CY 2023 MPFS proposed rule

CMS CY 2023 MPFS proposed rule fact sheet

IPPS proposed rule FY 2023

On April 18, 2022, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for fiscal year (FY) 2023 inpatient prospective payment systems (IPPS). The full document can be accessed here.

For FY 2023, which begins October 1, 2022, CMS is proposing to increase payment rates for hospitals that have successfully participated in the hospital inpatient quality reporting (IQR) program and are meaningful electronic health record (EHR) users by approximately 2.7 percent. This reflects the projected hospital market basket update of 3.1 percent, a 0.4 percent reduction of the productivity adjustment, and the 0.5 percent increase required by previous MACRA (Medicare Access and CHIP Reauthorization Act of 2015) legislation.

The SIR Economics Steering Committee reviewed the proposed rule and provides a detailed summary for members below.

SIR FY 2023 IPPS proposed rule summary

Public health emergency (PHE) extended

On April 12, 2022, the Secretary of Health and Human Services, Xavier Becerra renewed the public health emergency (PHE) due to the continued consequences of the Coronavirus Disease 2019 (COVID 19). The PHE has been extended for 90 days, now set to end on July 15, 2022.

Renewal of determination that a public health emergency exists

SIR’s first-ever IR revenue cycle and fundamentals course

On Apr 11, 2022, the SIR economics physician leadership hosted the society’s first IR revenue cycle and fundamentals course. This 6.5 live CME accredited course focused on the importance of revenue cycle, reimbursement policy, and application of appropriate coding and practice expenses within interventional radiology. It also scalped through the true future of interventional radiology in terms of understanding the day-to-day impact of proper clinical documentation, billing, auditing, and claims appeal. The course was successful, with 25 attendees, including physicians and practice administrators within academia, private practice, and office-based labs.

For those who missed the session, please know that an on-demand option will be available soon and will offer RCC and RCC-IR participation CEU conversion credits. More details will be provided in the upcoming weeks.

Thanks again to all speakers and attendees.

Clinical labor coalition letter urging Congress to stop devasting cuts

SIR, along with 22 specialty societies, signed onto the clinical labor coalition (CLC) letter urging Congress to add new funding to the Medicare physician fee schedule (MPFS) for the explicit purpose of increasing the non-facility/office-based practice expense relative value units (NF PE RVUs) negatively impacted by CMS’ recent clinical labor (CL) policy. CMS’s new policy will affect IRs practicing in an office-based setting by reducing CL reimbursement by -2% for CY 2022, with a four-year phase totaling -6% ending in CY 2025. The letter urges Congress to act and help mitigate these cuts that profoundly impact our IR practices. SIR Economics and Government Affairs team will continue to advocate. By conveying the need for our office-based practices to remain open and provide care to complex patients with severe health conditions to ensure these Medicare beneficiaries are not adversely affected by these significant cuts.

Clinical labor coalition letter

Inpatient prospective payment systems final rule GME slots FY 2022

On December 27, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule related to provisions implement policies based on legislative changes relative to Medicare graduate medical education (GME) for teaching hospitals provided by sections 126, 127, and 131 of the Consolidated Appropriations Act (CAA), 2021. In addition, this final rule with a comment period solicits comments on specific GME issues to inform potential future rulemaking. SIR provided formal comments to promote the increase of GME slots explicitly allocated to rural areas. Increasing the number of GME training positions for Interventional Radiologists will ensure patients have access to critical services for many essential IR procedures.

SIR GME comment letter

Congress reverses crippling Medicare cuts for CY 2022

On Dec. 10, President Biden signed the S. 610 bill, "Protecting Medicare and American Farmers from Sequester Cuts Act." The bill will continue the suspension of the 2% sequestration through March 2022, phasing in a 1% cut for April 1, 2022, through June 30, 2022. The bill also addresses an extension of the conversion factor (CF) increase. Services provided on or before December 31, 2021, will continue to see a 3.75% increase to the conversion factor. Services provided on or after January 1, 2022, and before January 1, 2023, will see an increase of 3% to the conversion factor. Lastly, the statutory Pay-as-you-go (PAYGO) cut of 4% is delayed through the end of 2022.

Payment provisions:

Sequestration = -1% starting April 1- June 30, 2022
Conversion factor (CF) increase of 3% = -.85% to the CF and budget neutrality adjustment CY 2022
PAYGO= 0% for CY 2022
Supply & equipment final year phase-in = -3% to IR CY 2022
Clinical labor first-year phase in= -2% to IR CY 2022

New 2022 MPFS conversion factor is $34.6062, IR estimated cuts are 5.6%.

Thank you to all members who wrote to their congressional representatives to keep pressure on them. When Congress returns from the holiday recess, SIR will continue to advocate for necessary revisions to the clinical labor calculations that will offer much-needed relief to our members who operate outpatient labs.

Review the S.610 bill

SIR MPFS impact analysis CY 2022

AMA MPFS impact analysis CY 2022

SIR town hall MPFS

The Society of Interventional Radiology town hall aired on Nov. 29, 2021. The primary focus was regarding the Medicare physician fee schedule (MPFS) for CY 2022. Within this topic, we covered the conversion factor, clinical labor, impacts to IR procedures in a non-facility setting, VIRTEX, and SIR’s advocacy efforts to prevent the approaching cuts. Our advocacy and legislative teams continue to advocate until the last moment aggressively, but we need your help! SIR urges our members to participate in our latest Call to action to mitigate the impending Medicare pay cuts to IR.

SIR town hall MPFS recording

SIR town hall slides

SIR town hall MPFS Q&A

Call to action

VIRTEX SIR data registry

SIRPAC donation

Appropriate use criteria (AUC)

CMS repeals MCIT/R&N final rule

The Centers for Medicare and Medicaid (CMS) CMS has officially rescinded the MCIT/R&N final rule, there remain existing and proven pathways that allow for coverage of a specific medical device or service. Devices may still be covered through claim-by-claim determinations, one or more local coverage determinations, or a national coverage determination. SIR has agreed with the CMS proposal to repeal the MCIT/R&N ruling slated to take effect on Dec. 15, 2021. SIR continues to urge CMS that they must engage with specialty societies to provide recommendations on the valuation for the devices/related physician services within the MCIT pathway.

We will ensure to be present and contribute to these continued efforts. SIR will collaborate with other specialty societies as needed throughout this process to provide additional support to understanding the new technologies and the populations they are designed to serve.

MCIT/R&N final rule

Medicare physician fee schedule (MPFS) final rule

On Nov. 2, 2021, CMS’ published the final 2022 Medicare physician fee schedule rule. Notably, the 2022 Medicare conversion factor will be reduced by approximately 3.85% from 34.8931 (2021) to 33.5983. This is essentially a result of the expiration of a 3.75% increase to the conversion factor at the end of the calendar year 2021. CMS has stopped plans to implement clinical labor pricing revisions all at once for CY 2022 and instead agreed to phase it in over 4 years to minimize the effects on private practices and office-based labs. Estimated impacts for Interventional Radiology is approximately -5% as opposed to originally proposed -9%. SIR’s economics committee provides a summary and impact analysis below.

SIR MPFS summary CY 2022

SIR MPFS impact summary CY 2022

CMS MPFS final rule CY 2022

CMS MPFS fact sheet CY 2022

CMS quality payment program CY 2022

2022 hospital prospective payment system (HOPPS) final rule

On Nov. 2, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for the hospital outpatient prospective payment system (HOPPS) for CY 2022. The outpatient department (OPD) fee schedule will see a 2.0 percent increase. However, CMS will continue to apply a 2 percent reduction to the conversion factor for hospitals that fail to meet the hospital quality reporting requirements. Due to the impact related to the COVID-19 public health emergency (PHE) and pandemic, CMS used CY 2019 claims data for rate setting rather than CY 2020 due to the significant impact in the utilization of services. SIR’s economics committee provides a summary and impact analysis below.

SIR HOPPS summary CY 2022

SIR HOPPS impact analysis CY 2022

CMS HOPPS final rule CY 2022

CMS HOPPS fact sheet CY 2022

SIR signs onto the clinical labor coalition to CMS

SIR along with 12 other specialty societies signed onto the clinical labor coalition (CLC) letter for CY 2022 regarding the proposed Medicare physician fee schedule (MPFS) policies. The letter advocates for cost-effective, efficient, and safe healthcare. Outlining how the clinical labor proposal, if implemented, will jeopardize access to care for Medicare beneficiaries in non-facility offices. In the letter, we urge CMS not to implement this update for CY 2022. Instead, we are strongly recommending they consider adjustments to the scaling factor(s), analyze the budget neutrality options, publish non-BLS "other sources" wage data, update specific clinical labor wage rates based on stakeholder comments and data, consider the use of median wage rates, apply a more current fringe benefits multiplier, and analyze and publish codes with the most significant impacts.

CLC comment letter

Medicare coverage of innovative technology (MCIT) and definition of "reasonable and necessary" proposed rule

On Sept 15, 2021, the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (HHS) released a proposed rule that would repeal the Medicare coverage of innovative technology (MCIT) and definition of “reasonable and necessary” final rule, which was published on Jan. 14, 2021, and would be effective on Dec. 15, 2021. Under the final rule, MCIT would result in 4 years of national Medicare coverage starting on the date of FDA market authorization or a manufacturer chosen date within 2 years thereafter. The MCIT/R&N final rule would also implement regulatory standards to be used in making reasonable and necessary determinations under section 1862(a)(1)(A) of the Social Security Act for items and services that are furnished under Medicare parts A and B. SIR provided formal feedback and comments to CMS regarding the proposed rule and is available below.

SIR MCIT comment letter

2022 hospital prospective payment system (HOPPS) proposed rule

On July 19, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 hospital prospective payment system (HOPPS) proposed rule. The complete rule can be accessed at the following link: CY 2022 hospital prospective payment system (HOPPS) proposed rule. The proposed changes are geared towards the following initiatives: price transparency of hospital standard charges, radiation oncology model, and request for information on rural emergency hospitals.

The SIR Economics Steering Committee thoroughly reviewed the proposed rule and provides a detailed summary for members below. SIR provided formal feedback and comments to CMS regarding the proposed rule and is available below.

SIR HOPPS comment letter

SIR HOPPS summary proposed rule CY 2022

SIR HOPPS impact analysis CY 2022

CMS HOPPS fact sheet

2022 Medicare physician fee schedule (MPFS)

SIR’s comment letter for the proposed 2022 Medicare physician fee schedule (MPFS) was submitted on Sept. 8, 2021. SIR recommends CMS to retain the 3.75% conversion factor increase for the calendar year (CY) 2022 final MPFS. The Centers for Medicare and Medicaid Services (CMS) should not implement the clinical labor pricing updates. Interventional radiology will continue providing high-quality, innovative, and cost-effective services. IR will continue fighting in the frontlines of the COVID-19 pandemic. IR will continue servicing critical life-saving procedures for those in the underserved and at-risk communities. If CMS is genuinely dedicated to closing the health equity gap, the agency should not implement the proposed cuts. As a result, IR practices will negatively impact and disincentivize providers from opening office-based labs in disadvantaged communities. It will also limit patient access to critical services for many critical procedures such as:

Hemorrhagic and ischemic strokes
Maternal health (antepartum, intrapartum and postpartum hemorrhaging)
PAD (limb salvage)
Dialysis access (creation and revision AVF, AVG, and central lines)
Radiation oncology and other innovative cancer treatments
Pain management such as non-opioid alternatives

SIR MPFS comment letter

MPFS comment analysis

The Society of Interventional Radiology (SIR’s) legislative team has worked diligently on finalizing a heatmap to show current revisions to payment policies and how they will affect various interventional radiologists across the country. This analysis shows the VoterVoice summary of 15,000 (and growing) comments submitted on the Medicare physician fee schedule (MPFS).

2022 inpatient prospective payment system (IPPS) final rule

On Aug 2, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for fiscal year (FY) 2022 inpatient prospective payment system (IPPS). The complete rule can be accessed at the following link: inpatient prospective payment system (IPPS) final rule (FY) 2022. The final changes are tailored towards the following initiatives: quality programs and Medicare promoting, interoperability program requirements for eligible hospitals and critical access hospitals, changes to Medicaid provider enrollment, and changes to the Medicare shared savings program.

(FY) 2022 OSD rate-setting – there was a 2.5 percent increase to the inpatient payment rates was finalized by CMS for FY 2022. Due to the (FY) 2020 data being significantly impacted by the COVID-19 PHE, CMS finalized the use of FY 2019 claims data for rate setting. A one-year extension for add-on payments was finalized for Eluvia™ drug-eluting vascular stent. Ellipsys® vascular access system and INDIGO aspiration system with lightning aspiration tubing (INDIGO® with lightning) were not approved for new technology add-on payments for FY 2022. CMS finalized non-O.R. status for open revision and removal of devices from subcutaneous tissue and fascia and percutaneous tunneled vascular access devices. CMS has finalized a change for percutaneous revision of intraluminal devices from non-O.R. status to O.R. status as these procedures typically require resources in the operating room. All changes go into effect on Oct. 1, 2021.

The SIR Economics Steering Committee is thoroughly reviewing the final rule for comment and a detailed summary is provided below.

SIR IPPS final rule summary (FY) 2022

CMS’s proposed decision memo for a national coverage determination (NCD) of transvenous (catheter) pulmonary embolectomy (240.6)

On August 11, 2021, the Centers for Medicare & Medicaid Services (CMS) posted a decision memo proposing to remove the national coverage determination (NCD) for transvenous (catheter) pulmonary embolectomy (NCD 240.6), permitting Medicare coverage determinations for transvenous (catheter) pulmonary embolectomy to be made by Medicare administrative contractors (MACs). CMS states in the memo, “Allowing MACs to determine coverage of catheter embolectomy for patients with acute PE is clinically appropriate and in the best interest of our beneficiaries”. SIR’s economics committee collaborated with our venous service line writing comment letters to CMS asking CMS to remove NCD 240.6 for the past two years. These efforts may have paid off pending the final comment period of the proposal. SIR’s economics committee will continue to monitor this proposal and work with regional MACs on coverage determinations for transvenous (catheter) pulmonary embolectomy.

CMS’s NCD 240.6 proposed decision memo

SIR NCD 240.6 comment letter

2022 hospital prospective payment system (HOPPS) proposed rule

On July 19, 2021, the centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 hospital prospective payment system (HOPPS) proposed rule. The complete rule can be accessed at the following link: hospital prospective payment system (HOPPS) proposed rule (CY) 2022. The proposed changes are geared towards the following initiatives: price transparency of hospital standard charges, radiation oncology (RO) model and request for information on rural emergency hospitals.

CY 2022 OSD rate setting – 2022 Medicare conversion factor would be increased by approximately 2.3% to the outpatient department (OPD) fee schedule. CMS is proposing a 2 percent reduction to the conversion factor for hospitals that failed to meet the hospital quality reporting requirements. Due to the COVID-19 impact in the utilization of services, CMS is proposing to use CY 2019 claims data rather than CY 2020 for the rate-setting.

The SIR Economics Steering Committee thoroughly reviewed the proposed rule and provides a detailed summary for members below. SIR intends to provide formal feedback and comments to CMS regarding the proposed rule by September 17, 2021. When complete, the comment letter will be available to all SIR members.

SIR summary HOPPS proposed rule (CY) 2022

SIR HOPPS impact analysis (CY) 2022

CMS HOPPS fact sheet

2022 Medicare physician fee schedule (MPFS) proposed rule

On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare physician fee schedule (MPFS) proposed rule. The complete rule can be accessed at the following link: (CY) 2022 Medicare physician fee schedule (MPFS) proposed rule. The proposed changes are heavily geared towards the following initiatives: changes to Medicare part B payment policies focused on medical practice management, the relative value of services, and changes in the existing statute. The proposed rule also made significant updates to the quality payment program (QPP), coverage of opioid use disorder services furnished by opioid treatment programs, and certain Medicare provider enrollment policies. There are now requirements for prepayment and post-payment medical review activities, electronic prescribing for controlled substances for a covered part D drug under a prescription drug plan, or a Medicare Advantage prescription drug (MA-PD) plan. In addition, the Medicare diabetes prevention program (MDPP) will be expanded and amendments will be made to the physician self-referral law regulations.

The components of the proposed rule that impact IR more directly and that SIR staff will be preparing comments for are highlighted below.

Payment provisions

CY 2022 PFS rate-setting – 2022 Medicare conversion factor would be reduced by approximately 3.89% from $34.8931 to $33.5848. Based on Table 123: (CY) 2022 PFS estimated impact on total allowed charges by specialty, IR is proposed to see a 9% decrease in reimbursement, with the greatest impact on practice expense reimbursement, due to updated clinical labor and supply/equipment values. These proposed value changes could result in decreases to code and code set payments which may be less than or more than the estimated -9% overall impact.

TABLE 123: CY 2022 PFS estimated impact on total allowed charges by specialty

(A) Specialty

(B)

Allowed

Charges (mil)

(C)

Impact of Work RVU

Changes

(D)

Impact of PE

RVU

Changes

(E)

Impact

of MP RVU

Changes

(F)

Combined

Impact

Interventional Radiology

$480

-9%

Radiology

$4,397

-2%

SIR's Economics Steering Committee thoroughly reviewed the proposed rule and provided a summary for members below. SIR intends to provide formal feedback and comments to CMS regarding the proposed rule by September 13, 2021. When completed, the comment letter will be available to all SIR members.

SIR summary (CY) 2022 MPFS proposed rule

2022 MPFS impact analysis

On July 1, 2021, CMS proposed changes to the ESRD prospective payment system

The Centers for Medicare and Medicaid Services (CMS) have heard concerns from stakeholders on a variety of issues related to peritoneal dialysis (PD) catheter placement, including the lack of availability to perform PD catheter placements, lack of appropriate operating room time, and a lack of training on PD catheter placement. This proposed rule would update the end-stage renal disease (ESRD) prospective payment system (PPS) for the calendar year (CY) 2022. CMS is seeking feedback about how CMS can test and use the Medicare payment policy, under the ESRD treatment choices (ETC) model, to promote the placement of PD catheters. SIR's Economics team provides a summary below and plans to submit a comment.

SIR summary CMS ESRD proposed rule

CMS ESRD proposed rule

CMS ESRD fact sheet

Quarterly coding updates that will go into effect July 1, 2021, were released by CMS and AMA

Quarterly updates from CMS for new HCPCS codes, medical unlikely edits (MUEs), procedure-to-procedure (PTP) edits and national correct coding initiative (NCCI) edits for interventional radiologists who bill under both the Medicare physician fee schedule (MPFS) and hospital outpatient prospective payment system (HOPPS) were released. The AMA also released quarterly updates for CPT® Category III codes. All changes go into effect on July 1, 2021.

HCPCS codes effective July 1, 2021

SIR summary quarterly facility PTP and MUE update

SIR summary quarterly practitioner PTP and MUE update

AMA CPT® Category III codes

CMS’s decision memo for a national coverage determination (NCD) of transvenous (catheter) pulmonary embolectomy (240.6)

On May 13, 2021, SIR submitted comment and a letter to CMS for removal of national coverage determination (NCD) for transvenous (catheter) pulmonary embolectomy (240.6). The policy for NCD 240.6 has not been reviewed or updated since 1987. In the original analysis of the policy, CMS indicated that the transvenous (catheter) pulmonary embolectomy procedure was experimental with little to no supporting evidence qualifying it medically necessary for coverage. However, over the last 30 years, there has been substantial evidence that proves the procedure as a concrete, medically necessary procedure to treat pulmonary embolism. The SIR letter provides current evidence supporting the removal of NCD 240.6 as it prevents access for patients with life-threatening PE to a well-established, lifesaving procedure with few other alternative options. We strongly recommend that CMS invokes the expedited process established in the August 7, 2013, Federal Register (78 FR 48164) to remove this NCD.

SIR comment letter

Updated Apr 14, 2021. 2021- 2% sequestration cuts extended untill the end of the year

Background Information:

Aug.2020 - The original cuts indicated by the proposed rule were for IR to take an -8% cut to IR services reimbursement.
Nov. 2020 - The final rule maintained these same measures at -8% cut to IR services.
Late Dec. 2020 – Congress passed a $900 billion COVID-19 economic relief and $1.4 trillion government funding package that gives critical pandemic aid to Americans while securing federal agency operations through Sept. 2021. The COVID-19 economic relief bill was passed, which contributed $3 billion to supplement physician reimbursement and provide relief from final rule cuts. Such an initiative reduced the cut to IR reimbursement from -8% to -2%, and an extension of the deadline by which the coronavirus aid, relief, and economic security (CARES) act coronavirus relief fund (CRF) Resources must be spent was extended to Dec. 31, 2021. For more details, click here.
Early Jan. 2021 - The sequestration indicated that the implementations of the changes mentioned above would be imposed in March 2021 instead of Jan 2021). However, part of the sequestration also included that the pay-as-you-go act of 2010 would be part of the implementation after Sept. 2021. For the SIR summary, please click here. Based on the current rates associated with the pay-as-you-go act, SIR anticipates that IRs will experience an additional -2% or -3% cut to its existing reimbursement structure. Therefore, the actual impact in reimbursement for IR will be a -2% from Mar. to Sept 2021 and a -4% or -5% cut from Oct. to Dec. 2021.
Mar 30, 2021, 2% sequester reduction suspension Medicare Administrative Contractors (MACs) were instructed to hold all claims with dates of service on or after Apr. 1, 2021, minimizing the volume of claims the MACs must reprocess. So, for this short period, IRs will not see a financial impact on their cash flow until implementation is executed. The MACs will automatically reprocess any claims paid with the reduction applied. As of today, on Apr. 1, 2021, SIR has reviewed all announcements from each MAC and has not seen any implementation schedule for these changes. We will continue to monitor all the MACs and update SIR members of any new changes. We anticipate that with the upcoming 2022 proposed rule scheduled for release in July 2021, SIR does not expect this aspect of the sequestration to be activated for the calendar year of 2021.

Current Updates:

On April 14, 2021, President Biden signed into law H.R.1868 - To prevent across-the-board direct spending cuts, and for other purposes, now known as public law No: 117-7. This congressional and presidential action is in response to the 2% sequestration moratorium which had been extended as part of the consolidated appropriations act of 2021, signed into law at the end of 2020, but was scheduled to end March 31, 2021. This new law now extends the payment moratorium through December 31, 2021.

Next Steps:

CMS released a notification on Friday, April 16th it will begin processing claims submitted with dates of service on or after April 1st. In addition, any claims which may have been processed with the 2% reduction will be reprocessed. Providers do not need to take any action at this time. Please feel free to reach out to the SIR economics team for more details or questions.

On Jan. 21, 2021, the Office for Civil Rights, Office of the Secretary, and HHS published a purposed rulemaking to update and add clarity to definitions or terms used in regard to HIPAA Rules

SIR economics team has a full summary of the purposed rulemaking. Please click on the link below for more information.

SIR HHS purposed rulemaking summary

Updated Jan. 5, 2021 - CMS releases CY 2021 Final Rule for Medicare Physician Fee Schedule (MPFS).

On Dec 1, 2020, the Centers for Medicare & Medicaid Services (CMS) published the final rule for CY 2021 CMS Medicare physician fee schedule (MPFS). The final rules have updated payment policies, payment rates, and quality provisions for services furnished under the Medicare physician fee schedule (MPFS) took effect on or after Jan 1, 2021. Under the current MPFS, interventional radiology services will see an 8% cut in reimbursement, and radiology will see a 10% reduction. (see Table 106).

SIR economics team has a full summary of the (CY) 2021 final rule and its impact on interventional radiology services. Please click on these links for the full summary of the impact of MPFS and HOPPS on interventional radiology.

CY 2021 SIR MPFS final rule summary

CY 2021 IR Codes est. SIR impact analysis

CY 2021 SIR HOPPS final rule summary

CY 2021 IR Codes OPPS est. SIR impact analysis

CMS has finalized a significant budget neutrality adjustment wherein the CY 2021

The physician payment conversion factor is $32.41, a decrease of $3.68 from the CY 2020 conversion factor of $36.09. This is an overall decrease of 10.2%. CMS also adopted the relative value recommendations made by the AMA/Specialty Society RVS Update Committee (RUC) for the office and outpatient E/M visits. According to the AMA, although the surgical specialties participated in the RUC survey and their data and vignettes were incorporated into the RUC recommendations, in the final 2021 E/M policies, CMS did not apply the RUC recommended values to the visits bundled into global surgical payments.

For a quick review of the upcoming changes, please review the following:

Fact sheet for CY 2021 MPFS

CY 2021 quality payment program final rule fact sheet and FAQs

CY 2021 CMS Medicare physician fee schedule (MPFS)

Trump administration finalizes permanent expansion of Medicare telehealth services and improved payment for time doctors spend with patients

SIR comment letters to CMS

SIR always submits comment letters to federal agencies, CMS, and insurance carriers that specifically address interventional radiology treatments.