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.

Without congressional intervention, these policies will result in significant cuts to physician payment for most surgical services delivered to Medicare patients, destabilize health system financing, and drastically diminish the opportunity for physician offices to recover financially from COVID-19.

E/M Global Surgical Codes Changes

In the CY 2021 Medicare Physician Fee Schedule (PFS) proposed rule, CMS restated their plan to increase the payment levels for stand-alone office and outpatient E/M codes. It did not, however, apply these adjustments to global codes. This change was first finalized in the CY 2020 PFS rule, but the changes would not take effect until 2021. Arbitrarily adjusting some E/M codes but not others conflicts with the Omnibus Budget Reconciliation Act (OBRA) of 1989(P.L. 101-239), which prohibits Medicare from paying physicians differently for the same work. Failing to adjust the E/M portion of the global codes is tantamount to paying surgeons less than physicians in other specialties, in contradiction of the law. Ask Congress to waive Medicare’s budget neutrality requirements — as stipulated in Section 1848(c)(2) of the Social Security Act — for the finalized evaluation and management (E/M) code policies.

Cuts to Musculoskeletal Care Services

In the CY 2021 Medicare PFS proposed rule, CMS proposes 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 proposes 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. These changes will have a severe and lasting impact on access to care for America’s seniors. Ask CMS to maintain current funding levels, and accept the data provided by the American Association of Orthopaedic Surgeons (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.