Payment Policy Changes

As physicians continue to care for patients on the frontlines of the COVID-19 pandemic, cuts to physician payment for surgical services are looming. Finalized and recently proposed policies from the Centers for Medicare & Medicaid Services (CMS) conflict with current law and will have drastic consequences for Medicare patients seeking surgical services at a time when physician practices are struggling to stay afloat.

E/M Global Surgical Codes Changes

In 2019, CMS finalized a proposal to revalue evaluation and management (E/M) office/outpatient visit codes but failed to extend the updates to global surgical codes. Now for 2021, CMS is proposing to extend the updates made to office/outpatient E/M visits to certain bundled services. It failed again, however, to incorporate these RUC-recommended increases for the revised office/outpatient visit E/M codes in the global surgical codes. We need your help calling on Congress to take immediate action to stop the proposed 5% cut to orthopaedics and to require CMS to apply the increased E/M adjustment to 10- and 90-day global code values.

H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, would provide necessary relief to orthopaedic surgeons who are expected to see significant payment cuts in 2021. The bill, introduced by Reps. Ami Bera, MD (D-CA-07), Larry Bucshon, MD (R-IN-08), Brendan Boyle (D-PA-02), George Holding (R-NC-02), Raul Ruiz, MD (D-CA-36), Phil Roe, MD (R-TN-01), Abby Finkenauer (D-IA-01) and Roger Marshall, MD (R-KS-01), would prevent cuts to Medicare payment for surgical services, ensuring that surgeons will not face devestating changes.

Write your representative today asking them to cosponsor H.R. 8702, prevent cuts to Medicare payment for surgical services.

Cuts to Musculoskeletal Care Services

In the CY 2021 Medicare Physician Fee Schedule (PFS) rule, CMS has proposed to follow through with two major funding cuts for orthopaedic surgery. The proposed physician conversion factor is $32.26, an 11% reduction from 2020. In addition, CMS has proposed to accept the AMA-RUC recommendations to decrease the work relative value units (RVUs) for hip and knee arthroplasty CPT codes 27130 & 27447 from 20.72 to 19.60. If finalized, these changes will have a severe and lasting impact on access to care for America’s seniors.

The AAOS, as well as individual orthopaedic surgeons, asked CMS to maintain current funding levels. We argued that the agency should accept the data provided by the AAOS and the American Association of Hip and Knee Surgeons (AAHKS), which demonstrates increased surgeon time spent on evaluation activities related to value-based care. 

As CMS begins reading through stakeholder feedback and finalizing the rules, the AAOS will continue to advocate its position and work closely with the agency on further improving the payment system and ultimately enhancing the care of musculoskeletal patients.