The year 2022 has brought many significant changes in the Medicare program, including another last-minute cliffhanger for physician reimbursement.

Q. What 2022 coding changes affect retina?

A. The single biggest impact affecting retina specialists is the change to the global period for CPT 67141 (prophylaxis retinal tear, cryo) and CPT 67145 (prophylaxis retina tear, laser). These codes changed from having a 90-day global period to a 10-day global. The restriction in CPT of “one or more sessions” was also removed.

This revision changes the status of these procedures from major to minor surgeries. As such, an exam on the same day is now subject to the modifier 25 rule and is only payable if there is also a separate and distinct reason for the visit. The revision also triggers a significant effect on payment rates, with 67141 dropping 49% in office and 56% in a facility, and 67145 down by 54% in office and 57% in a facility.

Q. What else is happening with physician reimbursement?

A. The 2022 Medicare Physician Fee Schedule (MPFS) Final Rule was published on November 19, 2021. The 2022 MPFS conversion factor was $33.5983, down 3.78% from $34.8931 in 2021, primarily due to the expiration of the one-time 3.75% payment increase in the 2021 Consolidated Appropriations Act.

As happened at the end of 2020, Congress stepped in and made last-minute changes. The 2022 MPFS conversion factor is now $34.6062 — bringing many fees back nearer to 2021 levels, especially for office and outpatient visits. No ophthalmic procedures received large increases in physician payments.

Aside from the conversion factor, many codes saw relative value (RVU) changes. Tables 1 and 2 show the changes, for surgery and tests, respectively, ranked in CPT order (all values are national Medicare Physician Fee Schedule allowed amount for participating providers). As you can see, most codes had very modest changes. RP