The Centers for Medicaid & Medicare Services (CMS) has released the final rule for the Physician Fee Schedule (PFS) for 2022. This will include updates on policy changes that will take place January 1, 2022. This fee schedule is the basis of how Medicare payments are made.

Here are a few key points taken from the fee schedule for the 2022 calendar year.

Evaluation and Management (E/M) Visits

The new update finalizes some policies regarding Evaluation and Management (E/M) visits. These involve:

Split or Shared E/M Visits

This is to better reflect the involvement of non-physician practitioners (NPPs) as part of the care team in certain circumstances. It clarifies situations that must be met to bill Medicare for these services. It will establish items such as the definition of what a split visit is, the documentation of who performed the split visits, etc.

Critical Care Service

The new PFS will define how critical care services can be paid. For example, one part establishes that if an E/M service was provided before a critical care service, at a time when the critical care service was not required, then the critical care service may be paid on the same day as other E/M codes if performed by same provider or another provider in the same specialty group, using modifier -25.

Teaching Physician Services

Establishes what is appropriate for E/M services coding in teaching situations where a resident is performing services under supervision of a teaching physician.


The telehealth section finalizes the inclusion of Medicare telehealth services that were temporarily added during the COVID-19 Public Health Emergency. It states that this will be extended through the 2023 calendar year. For mental health disorders, the patient’s home will be an allowed site for telehealth services, with rules on the requirement for non-telehealth visits. Lastly, amendments will be made that allow audio-only communications for mental health services in situations where the provider has the capability to communicate using two-way audio/video interactions, but where the patient does not or does not consent to.

Vaccine Administration Services

For the administration of preventative vaccines, the payment for influenza, pneumococcal and hepatitis B vaccines will be $30 per dose, starting January 1, 2022. Meanwhile, the COVID-19 vaccines payment remains at $40 per dose. Once the Public Health Emergency is declared over, the payment for COVID-19 vaccines will adjust to similar rates as other preventative vaccines in the same category. Other updates are related to the in-home administration of the COVID-19 vaccine and COVID-19 monoclonal antibody products.

Clinical Laboratory Fee Schedule

The Clinical Laboratory Fee Schedule provides a fee for specimen collections and a fee to cover travel expenses for the trained personnel when they must get the collections from a homebound patient or inpatient facilities (not including hospital inpatients). Rules were changed to provide payment to independent laboratories for these types of specimen collections, in certain situations. There will be a fee increase for these services which will last until the end of the Public Health Emergency; however, the CMS have collected comments regarding the policies for collections fees which they will take into consideration for future rulemaking.


Other points of this update include items such as Opioid Treatment Program payment policies, Rural Health Clinics and Federally Qualified Health Centers, Medicare Shared Savings Program, etc. For more detail, you can check out the CMS Fact Sheet.

At Americare Network, we will keep up-to-date with different policy changes and different fee schedules for each calendar year. Contact us today to learn more about how we can help your healthcare practice with your medical billing needs.