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- Advocacy Win: CAP-Created Consult Codes Included in Proposed 2022 Medicare Payment Regulation
On July 13, the Centers for Medicare & Medicaid Services (CMS) released the proposed 2022 Medicare physician fee schedule (PFS) by including CAP-developed pathology Consult Codes. The CAP successfully advocated for the inclusion of new and improved codes and values for pathology consultation services in the proposed 2022 Medicare Physician Fee Schedule.
The CAP worked with the American Medical Association’s (AMA) CPT Editorial Panel to improve the pathology consultation codes and develop new payment rates through its role in the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The Centers for Medicare & Medicaid Services (CMS) accepted the new code family proposed by the CAP in the 2022 Medicare proposed fee schedule.
The CAP applauds the CMS proposed decision to implement the new pathology clinical consultation services in 2022. The new pathology clinical consultation services (80XX0, 80XX1, 80XX2, 80XX3) 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.
According to the CMS reimbursement for pathology services would decrease by 1% due to changes practice expense pricing.
In addition, the proposed 2022 conversion factor used for the fee schedule’s payment formula is $33.5848, representing a 3.75% decrease from the 2021 conversation factor. This 3.75% decrease to the conversion factor stems from Medicare policy to offset increases to other physician services such as any increases to evaluation and management services.