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Medicare Fee Schedule Rule Finalizes Huge Payment Cuts for SGO Members and Other Surgical Specialties

Member Update
Dec 2, 2020

On Dec. 1 the Centers for Medicare and Medicaid Services (CMS) issued the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) rule finalizing devastating payment cuts for surgical specialties and other clinicians to pay for the payment increases for Evaluation and Management (E/M) office visits and other expenditures. Despite strong advocacy from SGO and the surgical community, the MPFS final rule sets the CY 2021 conversion factor at $32.41, a decrease of $3.68 from the CY 2020 MPFS conversion factor of $36.09. Please send Congress a message to address these payment cuts through the SGO Advocacy page.

The conversion factor reflects the statutory update of 0.00% and the budget neutrality adjustment necessary to account for the E/M code payment increases, new add-on codes for complex office care and for prolonged office/outpatient E/M visits, increases in valuation of many services that CMS considers similar to E/M office visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, and physical and occupational therapy evaluation services, in addition to other expenditures. The reduction in the conversion factor results in up to a 5% payment cut for gynecologic oncology and up to 9% for some surgical specialties. These cuts will be implemented on Jan. 1, 2021.

The only way now to stop the Medicare payment cuts is through congressional action. The SGO continues to work with colleagues in the surgical community to urge Members of the House of Representatives to pass H.R. 8702, Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020, sponsored by Rep. Ami Bera and Rep. Larry Bucshon. Passage of this bill will stop the payment cuts and preserve patients’ access to surgical care. And while there is not a companion bill to H.R. 8702 in the Senate, SGO continues to urge Senators to find bipartisan solutions to block the Medicare physician payment cuts before adjourning the 116th Congress at the end of this year. SGO members are urged to visit the SGO Advocacy page to send prewritten messages to federal lawmakers requesting swift action to stop the Medicare payment cuts.

The MPFS final rule also implements simplified coding and documentation changes for Medicare billing for E/M office visits that will go into effect beginning Jan. 1, 2021. The changes modernize documentation and coding guidelines to significantly reduce the burden of documentation. Clinicians will now be able to choose the visit level based on either guidelines for medical decision-making or time dedicated with patients.

The MPFS rule finalizes the proposed expansion of telehealth services by adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the COVID-19 public health emergency (PHE). CMS states that these additions allow beneficiaries in rural areas who are in a medical facility, like a nursing home, to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. CMS announced a commissioned study of its telehealth flexibilities provided during the COVID-19 PHE. The study will explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.

The SGO will provide additional updates on the details of the 2,100+ page MPFS rule once it has been fully reviewed, including changes to the Medicare Quality Payment Program.  For more information please go to the following links: