With a new year, there are several new laws and regulations now impacting pathologists and their practices. Below is a recap of what changes you should know for 2022.

New Pathology Clinical Consultation Codes

The CAP worked with the American Medical Association’s (AMA) CPT Editorial Panel to establish pathology clinical consultation codes and develop new payment rates, through the CAP’s role in the AMA/Specialty Society Relative Value Scale Update Committee (RUC), for 2022. The four new pathology clinical consultation services describe physician pathology clinical consultation services provided at the request of another physician or qualified health care professional at the same or another facility or institution. The distinction among the new code family involves a degree of complexity and/or time of service, broken down by 20-minute increments each for codes 80503, 80504, and 80505, along with an add-on code 80506 reflecting additional 15–30-minutes above that spent on CPT 80505.

Register for a webinar to review these codes on January 20.

Medicare Cuts Mitigated for 2022

On December 9, Congress responded to the CAP’s Advocacy by passing the Protecting Medicare and American Farmers from Sequester Cuts Act. The legislation increased payments on the Medicare Physician Fee Schedule in 2022 by 3%. The Centers for Medicare & Medicaid Services (CMS) followed by implementing the provisions in the law and increasing the conversion factor used to calculate Medicare physician fee schedule rates to $34.6062 from $33.5983.

The CAP updated its analysis of Medicare payment changes to pathologists. Download our 2022 Medicare Physician Fee Schedule impact table showing these changes.

No More Surprise Medical Bills

Provisions in the No Surprises Act, enacted in 2020, took effect on January 1, 2022. On December 7, the CAP hosted a webinar where experts reviewed the details of the No Surprises Act and how it affects pathologists. Check out the recording and download the slides.

The federal government issued its first interim final regulation in July 2021 regarding patient-cost sharing protections, notice and consent standards for waivers, rules to calculate qualifying payment amounts, disclosure requirements, and complaints processes. Unfortunately, the government issued a second interim final regulation in September 2021 that gives insurance companies the upper hand during the independent dispute resolution process where physicians and insurers can fairly resolve disputes. Read the CAP’s letter to the HHS detailing the problems with the regulation and how the CAP proposed to fix it.

On December 23, the CAP filed an amicus brief in support of a lawsuit challenging the government’s flawed implementation of the act.