On Tuesday, July 13, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule citing potential revisions to payment policies under the physician fee schedule (PFS) and other Part B payment policies. AASM staff will review the rule in its entirety and will work with AASM volunteers and leadership to submit comments on behalf of the AASM membership.

Highlights of the proposed rule that may impact sleep medicine include:

  • The PFS conversion factor for calendar year 2022 is proposed to be significantly decreased from $34.89 to $33.58.
  • CMS is proposing several refinements to current policies for evaluation and management (E/M) visits, critical care visits, and services furnished by teaching physicians involving residents.
  • Additional proposals are also included to refine policies for split/shared E/M visits.
  • CMS added several new codes to the Medicare Telehealth list during the COVID-19 public health emergency and is now proposing to extend coverage of these services until the end of 2023.
  • CMS is continuing the initiative to update pricing data for supplies and equipment, directly impacting Practice Expense, which accounts for a part of total reimbursements.
  • CMS is proposing to update the underlying rate data for clinical labor costs, which is also a part of Practice Expense.
  • CMS is amending regulations to allow physician assistants to directly bill Medicare.
  • CMS is proposing to increase the Merit-based Incentive Payment System (MIPS) performance threshold.
  • CMS is proposing a timeline to sunset traditional MIPS at the end of 2027 for implementation of MIPS Value Pathways (MVPs).
  • The agency is also soliciting comments on data collection efforts to promote health equity and patient access.

The proposed rule and a CMS Fact Sheet are currently available for review. Comments can be submitted to CMS (file code CMS-1751-P) at regulations.gov until Sept. 13, 2021.

View more Medicare resources from the AASM.