Published 11/12/2018

AAOS on Potentially Misvalued Codes in 2019 Medicare Physician Fee Schedule

Washington, DC—American Association of Orthopaedic Surgeons (AAOS) President David A. Halsey, MD, today issued the following statement in response to the Centers for Medicare and Medicaid Services (CMS) identifying potentially misvalued current procedural terminology (CPT) codes in the newly released 2019 Medicare Physician Fee Schedule Final Rule:
“The AAOS strongly disagrees with the assumption that the seven high-volume CPT codes, including 27130 (total hip arthroplasty) and 27447 (total knee arthroplasty), are potentially misvalued. Since they were last revalued by the RVS Update Committee (RUC) and CMS in 2013, there hasn’t been any evidence to suggest a change in physician work or practice expense.
“The nature of the reevaluation request is also problematic, which was made by a large for-profit managed care health insurance company. CMS did not identify the source, nor did it make the full communication publicly available in the proposed rule. We are troubled by this lack of transparency and failure to disclose a potential conflict of interest.
“Given these concerns, we do not believe that any further action is warranted and would advise against a review by the RUC and CMS. These procedures save the United States economy a combined $28 billion in lifetime societal savings, and any change to their relative value units (RVUs) could impair patient access to high quality orthopaedic care.” 
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