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Physician Assistants Paid Directly from Medicare Starting in 2022

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Starting January 1st 2022, changes within Medicare’s physician fee schedule will take effect. These changes that were issued on November 2nd, 2021, will update policies for Medicare payments. “The calendar year (CY) 2022 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation,” (CMS, 2021).

Previously, for a majority of services that were performed in the office setting, Medicare made their payments on a single rate based on the resources involved in performing the service. Starting in 2022, CMS released a series of proposals that include standard rate-setting refinements. With these changes starting January 1st 2022, CMS is authorizing Medicare to make direct payments to physician assistants for services they perform under Medicare part B. As it stands right now, Medicare can only make payments to the employer or independent contractor. “The 2022 Physician Fee Schedule proposed regulatory changes would align policies with the Federal statute of the Consolidated Appropriations Act of 2021 [section 403]. The act amends the Social Security Act and removes the requirement that payment for services performed by PAs be made to their employer and allow payment to be made directly to a PA,” (DePalma).

Along with the changes to the PA PFS, these proposals “revise telehealth services under the Consolidated Appropriations Act, 2021, which allows use of audio-only communications technology when furnishing mental health services in certain circumstances. It also finalizes recent changes to Evaluation and Management (E/M) visit codes, such as policies for split (or shared) E/M visits, critical care services, and services furnished by teaching physicians. Modifications are also being made to payments for therapy services furnished in whole or in part by a Physical Therapist Assistant or Occupational Therapy Assistant. Updates to payment regulation for Medical Nutrition Therapy services are similarly being added as well as finalization for vaccine administration services,” (CMS, 2021).

Please follow this link for the original article pertaining to the above information.

Sources:

“Fact Sheet Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule.” CMS,

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee

 “Physician Fee Schedule.” CMS, https://www.cms.gov/Medicare/Medicare-Fee-for-Service

Payment/PhysicianFeeSched.

“Physician Assistants Will Benefit with Direct Pay under CMS Proposed Rule.” Healio,

https://www.healio.com/news/nephrology/20210812/physician-assistants-will-benefit-with

direct-pay-under-cms-proposed-rule.

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