Medicare Physician Fee Schedule Updates

Jan. 31, 2022

Below are updates to the Centers for Medicare and Medicaid Services’ (CMS) 2022 Medicare Physician Fee Schedule that may impact Medicare providers contracted with Blue Cross and Blue Shield of State (BCBSMT). See the CMS Fact Sheet for more information.

Critical Care Services

As of Jan. 1, 2022, providers should use the Current Procedural Terminology (CPT®) Codebook billing rules for critical care services. These replace the billing rules for critical care services in the Medicare Claims Processing Manual.

CPT codes for critical care provided by a single provider include:

  • 99291: First 30 to 74 minutes of critical care services provided to a patient on a given date. Providers may use this code only once per date.
  • 99292: Additional 30-minute time increments

Providers may aggregate non-continuous time for medically necessary critical care services.

Evaluation and Management (E/M) Shared Facility Visits

CMS is transitioning its billing rules for E/M shared, or split, services provided in facilities by a physician and a non-physician practitioner (NPP) in the same group:

  • As of Jan. 1, 2022: The provider who provides more than half the total time  – or who performs the history, exam or medical decision-making – can bill for the visit. An exception is critical care visits, when only the provider who provides more than half the total time can bill, rather than the provider who performed the history, exam or medical decision-making.
  • Starting Jan. 1, 2023: The provider who provides more than half the total time can bill for the visit.

Physician Assistant (PA) Services

As of Jan. 1, 2022, PAs may bill Medicare for professional services they furnish under Part B.

If you have billing questions, call the number on the member’s ID card. You can access fee schedules in Availity® and through our fee schedule request forms. Learn more under Claims and Eligibility and Standards and Requirements.

The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

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CPT[SH6]  copyright 2022 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.