The new year brings many significant changes in the Medicare program — and yet another last-minute cliff-hanger for physician reimbursement.

Q. What are the 2022 coding changes?

A. Eye care gets three NEW Category I CPT codes.

• 68841. Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculi, each (Report drug-eluting implant separately)
• 66989. Extracapsular cataract removal w/IOL insertion, complex; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more
• 66991. Extracapsular cataract removal w/IOL insertion; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

Two devices currently qualify as aqueous drainage devices for 66989 and 66991: the iStent and iStent inject (Glaukos), and Hydrus Microstent (Alcon).

The prior Category III codes used for these implants have been DELETED:

• 0191T. Insertion of anterior segment aqueous drainage device, without external reservoir; internal approach, into the trabecular meshwork
• +0376T. each additional device insertion

A NEW Category III code describes implantation of these devices as a stand-alone procedure:

• 0671T. Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without extraocular reservoir, and without concomitant cataract removal, one or more

Other NEW Category III codes for 2022 are:

• 0660T. Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach (Report medication separately)
• 0661T Removal and reimplantation of anterior segment intraocular nonbiodegradable drug-eluting implant (Report medication separately)

Treatment for amblyopia is getting five new codes:

• 0687T. Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session
• 0688T. Assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month

and

• 0704T. Remote treatment of amblyopia using an eye tracking device; device supply with initial set-up and patient education on use of equipment
• 0705T. ... surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days
• 0706T. ... interpretation and report by physician or other qualified health care professional, per calendar month

Finally, a new Category III code describes an injection into the posterior chamber of the anterior segment; Dexycu (dexamethasone intraocular suspension) 9% (EyePoint Pharmaceuticals) is an example:

• 0699T. Injection, posterior chamber of the eye, medication

CPT instructs: “The anterior segment of the eye includes the cornea, lens, iris, and aqueous. The aqueous is divided into anterior and posterior chambers. The anterior chamber is by far the larger, including all of the aqueous in front of the lens and iris and behind the cornea. The posterior chamber includes the narrow area behind the iris and in front of the peripheral portion of the lens and lens zonules.”

Q. What’s happening with physician reimbursement?

A. The 2022 Medicare Physician Fee Schedule (MPFS) Final Rule was published on Nov. 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. At the time of this writing, a revised 2022 MPFS including the additional funding by Congress has not been published, but we expect it shortly.

CMS estimated that year-over-year aggregate Medicare payments to ophthalmologists and optometrists would be unchanged. With the Congressional action in mid-December, we should see a net increase of about 2% — even after the phased-in sequestration is deducted from the physician payment.

Table 1 shows the effect of added funding on some common codes. For some ophthalmic surgical procedures, the Final Rule contained large reductions in the Medicare payment rates for 2022 (Table 2). All the reductions were made as a result of the updates recommended by the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC). The reductions for both 66174 and 66175 were due to the shorter operating time for ab interno surgeries vs the older ab externo procedure, which ophthalmologists seldom perform today.

The strabismus codes changed because the RUC review determined that they were over-valued.

The reductions for 67141 and 67145 were due to assignment of a shorter 10-day global surgery period vs the prior 90-day period. This revision changes these procedures from major to minor surgeries and affects the use of modifiers 57 and 25 with eye exams on the same day.

CMS established RVUs for 92229 and a national payment rate of $47. This service was previously contractor priced.

No ophthalmic procedures received large increases in physician payments. OM

Suzanne L. Corcoran, COE is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com .