American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS Seeks Congressional Intervention to Prevent Cuts to Payment for Surgical Services

Finalized policies from the Centers for Medicare and Medicaid Services (CMS) will have drastic consequences for Medicare patients seeking surgical services. These policies also conflict with current law, contradict past CMS action, and are unjustified. Without congressional intervention, these policies will result in significant cuts to physician payment for most surgical services delivered to Medicare patients, exacerbate surgical workforce shortages, and worsen the crisis of rural hospital closures.

E/M Global Code Policy Changes

In the Calendar Year (CY) 2020 Medicare Physician Fee Schedule (PFS) final rule published in November 2019, CMS increased the payment levels for stand-alone office and outpatient E/M codes. However, CMS did not apply the payment adjustment to the corresponding E/M portion of the global codes. Arbitrarily adjusting some E/Ms but not others conflicts with the Omnibus Budget Reconciliation Act (OBRA) of 1989 (P.L. 101-239), which prohibits Medicare from making Medicare payments to physicians for the same work but at different levels because of the physician’s specialty.

Add-On Code Policy Changes

In 2018, CMS proposed to restructure the coding system for office and outpatient E/M visits to reduce documentation burden. Because certain specialties would experience payment cuts, due to the proposed collapse of the payment levels, CMS proposed add-on codes to provide an additional payment specifically for primary care and certain specialty visits to minimize payment cuts associated with these code changes. However, CMS did not move forward with the single payment proposal and will instead retain the multiple levels of E/M codes. Therefore, CMS’ current justification for again including an add-on code (GPC1X) in the new E/M approach, no longer exists. Now instead of correcting a system that would have resulted in unfair payment reductions, the agency is creating a new coding scheme that inappropriately discriminates among physician specialties.

53 Health Care Organizations Urge Congress to Prevent Medicare Payment Cuts

E/M Global Code and Add-on Code Policy Changes Background

House Letter to CMS on Proposal to Not Update the E/M Component of Global Surgery Codes

Senate Letter to CMS on Proposal to Not Update the E/M Component of Global Surgery Codes

Take Action: Contact Congress and urge them to oppose cuts to physician payment for surgical services