I'm looking for

All Resources

E/M code changes scheduled for next year will result in Medicare payment cuts unless addressed

Coding ToolsAdvocacyCoding
Jun 18, 2020

The positive payment adjustments for Evaluation and Management (E/M) services provided in office and outpatient settings that were finalized as part of the Calendar Year 2020 Medicare Physician Fee Schedule, will adversely impact surgical payments and exacerbate the financial stress physicians and hospitals are experiencing from the COVID-19 pandemic.


In the 2020 final rule, the Centers for Medicare and Medicaid Services (CMS) decided not to provide positive updates to payments for E/M codes that will take effect in 2021 if the services are billed as part of a global surgical package. This provision unfairly targets surgeons and conflicts with current law that prohibits Medicare from making payments to physicians for the same work but at different levels because of the physician’s specialty. CMS is also moving forward with the implementation of a new add-on code providing additional payment specifically for primary care and certain cognitive specialty E/M visits originally intended to minimize the impact of payment cuts associated with previously proposed E/M code changes that CMS has since abandoned.


While some physicians will benefit from the E/M code adjustments and the new add-on code, Medicare Physician Fee Schedule budget neutrality requirements will result in a cut to Medicare’s conversion factor that will mean payment reductions across the physician fee schedule and significant cuts to physicians who do not bill a high volume of E/M codes in the office or outpatient setting. It has been estimated that these changes, scheduled to occur on Jan. 1, 2021, will result in Medicare payment cuts of over 2 percent when analyzing the specialty of gynecologic oncology as a whole.


The SGO is actively engaged in opposing these payment cuts and trying to mitigate the impact of the changes to the E/M codes. Working together with 18 surgical associations, SGO is part of a coalition that is calling on Congress to waive Medicare’s budget neutrality requirements under the Social Security Act for the finalized E/M code policies. This includes requiring that CMS apply the finalized 2021 office and outpatient E/M code adjustments to E/M services that are part of the post-operative visits for 10- and 90-day global surgical packages.  Jill Rathbun, Washington Consultant to SGO’s Health Policy and Socio-Economic Committee, is participating on behalf of SGO in coalition meetings with House and Senate Congressional offices to discuss this issue.


In the next few weeks, SGO members will be asked to contact Congress to effect change on this issue. There will be updates in SGO publications and  action alerts with instructions on how to contact your Representatives and Senators on this issue. It will require an “all hands on deck” effort since time is short with the cuts scheduled to occur on Jan. 1.  For more information on this issue read the new fact sheet prepared by the Surgical Coalition, of which SGO is a member, on the changes to E/M code payment policies.