Medicare Payment Cuts Threaten Surgical Reimbursement

Effective January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) will increase payment levels for standalone office and outpatient evaluation and management (E/M) codes, but will not apply this payment increase to the E/M portion of global surgical payments. Additionally, CMS created a new add-on code that will result in significantly increased spending in the Medicare Physician Fee Schedule. Since the Fee Schedule operates pursuant to “budget neutrality,” the combination of these factors will automatically result in significant decreases to reimbursement for other services, due to a large reduction to the conversion factor. Some surgical specialties will experience double-digit reductions in reimbursement.

While this large of a reimbursement reduction would present severe challenges in any year, it is particularly daunting at a time when surgical practices are still grappling with the devastating financial impacts of the pandemic. However, CMS has stated its commitment to implementation of these policies, despite significant and ongoing concern from stakeholders and Members of Congress.

Since a regulatory solution is not forthcoming, Congress must act before the end of the year to prevent the cuts from going into effect. Members of Congress are considering various policy solutions. Additionally, Congressman Bera (D-Calif.) and Congressman Bucshon (R-Ind.), both physicians, are requesting other Members of Congress to join them in urging congressional leadership to prioritize a legislative solution before the cuts go into effect. ASBrS continues to participate in virtual meetings with Capitol Hill to urge Members to sign onto the Bera-Bucshon letter to leadership, as well as to discuss legislative options. As of this writing, over eighty Representatives have signed on to the letter.

ASBrS also utilized the formal regulatory comment period on the proposed 2021 Fee Schedule to reiterate its concerns related to the proposed cuts, as well as to provide the Agency feedback on other policies in the proposed Fee Schedule. The other issues ASBrS commented included the revaluation of CPT 19307 and several policies related to the Merit-based Incentive Payment System (MIPS). Comments closed on Monday October 5, 2020; view the ASBrS Comment Letter (pdf). While the final rule for the Fee Schedule is typically in early November, this year, it is expected in early December as the public health emergency has affected traditional Agency timelines.

View ASBrS Comment Letter (pdf)

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