The Centers for Medicare & Medicaid Services (CMS) every year releases the Medicare Physician Fee Schedule (MPFS) to announce policy changes. In this blog, we shared important coding updates for the year 2022, applicable to urgent care services.
Reduced Conversion Factor
The Protecting Medicare and American Farmers from Sequester Cuts Act were signed into law on December 10, 2021. This law addresses the reduction in the 2022 Conversion Factor set by the Physician Final Rule, decreasing the 2022 Conversion Factor by 3 percent.
The new conversion factor becomes $34.61 compared to $34.89 in 2021. With the increase in Relative Value Units on most E/M codes, the impact on 2022 rates becomes minimal.
| Yr. 2021 | Yr. 2022 | |||
| Procedure Codes | RVUs | National Allowable | RVUs | National Allowable |
| 99202 | 2.12 | $ 73.93 | 2.14 | $ 74.04 |
| 99203 | 3.26 | $ 113.75 | 3.29 | $ 113.87 |
| 99204 | 4.87 | $ 169.93 | 4.9 | $ 169.59 |
| 99205 | 6.43 | $ 224.36 | 6.48 | $ 224.27 |
| 99212 | 1.63 | $ 56.88 | 1.66 | $ 57.45 |
| 99213 | 2.65 | $ 92.47 | 2.66 | $ 92.06 |
| 99214 | 3.76 | $ 131.20 | 3.75 | $ 129.79 |
| 99215 | 2.25 | $ 183.19 | 5.29 | $ 183.09 |
New POS for Telehealth
The Centers for Medicare & Medicaid Services (CMS) added a new Place of Service (POS) for telehealth services. New POS 10 represents telehealth services provided in the patient’s home. The description for POS 02 has also been revised to telehealth provided other than in the patient’s home. This new POS will be available for use after April 1, 2022.
Addition of Modifier 93
A new modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) became effective on January 1, 2022. This modifier allows reporting of medical services that are provided via real-time interaction between the physician or other qualified health care professional and a patient through audio-only technology.
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified healthcare professional and a patient who is located away at a distant site from the physician or other qualified healthcare professional. This modifier would be used for those payers that want phone calls billed with an E/M code instead of CPT’s time-based codes 99441-99443.
Diagnosis Codes for COVID-19 Immunization
As of April 2022, CMS has announced three new diagnosis codes, including two for COVID-19 immunization status. These codes were created mainly for hospital use in calculating inpatient reimbursement. Hospitals are paid based on resources commonly used for a diagnosis.
- Z28.310 Unvaccinated for COVID-19 (To be assigned when the patient has not received at least one dose of any COVID-19 vaccine)
- Z28.311 Partially vaccinated for COVID-19(To be assigned when the patient has received at least one dose of a multidose COVID-19 vaccine regimen but has not received the full set of doses)
- Z28.39 Another under-immunization status
Increased Allowable for Vaccine Administration
CMS has increased the allowable to administer influenza, pneumococcal, and hepatitis B virus vaccines to $30 from an average rate of $17.63 in 2021. This is for codes G0008 (influenza), G0009 (pneumococcal), and G0010 (hepatitis B). The amount is subject to a geographic adjustment.
Changed Description CPT 99211
In 2022, CPT 99211 descriptor reads as, office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician or other qualified healthcare professional. While the 2021 descriptor was, office or other outpatient visits for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.
Usually, the presenting problem(s) are minimal. The phrase ‘Usually, the presenting problem(s) are minimal’ has been deleted to bring the descriptor for CPT 99211 more in line with the rest of the office/outpatient evaluation and management (E/M) codes.
Services described by 99211 must be medically necessary (i.e., clinically indicated) and be part of a plan of care by a physician or other qualified healthcare professional. The mentioned are just for reference purposes only, for appropriate use of codes and modifiers, refer to the Medicare Physician Fee Schedule (MPFS).
MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle management services. If you need any assistance in medical billing and coding for urgent care services, contact us at info@medicalbillersandcoders.com/ 888-357-3226.
*CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association (AMA).
References:
ICD-10-CM Official Guidelines for Coding and Reporting FY 2022
What You Need to Know About 2022 Urgent Care Coding
FAQs
1. What is the Medicare Physician Fee Schedule (MPFS)?
The MPFS is released annually by CMS to announce policy changes and updates to reimbursement rates for healthcare services, including urgent care.
2. What is the new Conversion Factor for 2022?
The 2022 Conversion Factor is $34.61, a decrease from $34.89 in 2021, due to the Protecting Medicare and American Farmers from Sequester Cuts Act.
3. What is the new POS for telehealth services?
CMS introduced POS 10 for telehealth services provided in the patient’s home, effective after April 1, 2022, and revised POS 02 for telehealth outside the home.
4. What is Modifier 93 used for?
Modifier 93, effective January 1, 2022, is used to report synchronous telemedicine services provided via audio-only technology, such as phone calls with a healthcare provider.
5. What are the new diagnosis codes for COVID-19 immunization?
CMS introduced three new diagnosis codes for COVID-19 immunization status, including codes for unvaccinated and partially vaccinated individuals.
