September 19, 2023
In July, the Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2024 proposed rules for the Medicare Physician Fee Schedule (MPFS), the Outpatient Prospective Payment System (OPPS), and the Ambulatory Surgical Center (ASC) Payment System. These proposed rules contained several provisions of interest to surgeons, and the ACS in early September responded to CMS with detailed comment letters.
OPPS/ASC Proposed Rules
In its letter, the ACS requested that several anterior abdominal and parastomal hernia repair Current Procedural Terminology (CPT®) codes be removed from the Inpatient Only (IPO) list, which would make such codes eligible for reimbursement in the outpatient and ambulatory settings.
The College also urged CMS to maintain IPO status for certain bariatric and colectomy CPT codes, stating that patients undergoing these procedures require significant postoperative monitoring that cannot be safely provided in most outpatient departments.
The ACS also advocated for the alignment of quality efforts across CMS facility and physician programs, highlighting that the same emphasis should be put on quality in outpatient settings as is put on physician or inpatient facility quality programs, especially as more surgical services are directed to these settings.
MPFS Proposed Rule
In its letter, the ACS opposed implementation of add-on code G2211 for separate payment for office/outpatient evaluation and management (E/M) visits, stating that this code is unjustified, duplicative, not resource-based, and would result in overpayment for certain specialties while reducing payment for surgeons and increasing out-of-pocket costs for patients.
The College also provided an in-depth response to a series of questions posed by CMS regarding methods for accurately defining and valuing E/M and other services, including split (or shared) E/M visit.
In addition, the ACS opposed the proposed increase to the Merit-based Incentive Payment System (MIPS) performance threshold, which would burden physician practices that still lack essential resources with requirements that are not positively impacting the quality of care.