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SGO Calls on Congressional Leaders to Avert Medicare Physician Payment Cuts

Coding ToolsAdvocacyCoding
Jul 1, 2020

The SGO joined 52 other surgical and medical specialty societies in sending a letter to House Speaker Nancy Pelosi and Senate Majority Leader Mitch McConnell urging Congress to waive the budget neutrality requirements stipulated under the Social Security Act for the finalized Evaluation and Management (E/M) code proposal slated for implementation on Jan. 1, 2021. Congressional action to include a waiver in any forthcoming legislative package will provide a critical reprieve for SGO members and other surgical specialties that are facing substantial payment reductions in the coming months due to the E/M code changes and their impact on the conversion factor.

As reported in the previous SGO Issues, positive payment adjustments for E/M services provided in office and outpatient settings were finalized as part of the Calendar Year 2020 Medicare Physician Fee Schedule. However, the Centers for Medicare and Medicaid Services (CMS) decided not to provide the positive updates to payments for E/M services 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, including SGO members when they provide E/M services, 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 all other procedures that are not E/M codes. It has been estimated that these changes, scheduled to occur on Jan. 1, 2021, will result in Medicare payment cuts of over 2% for the specialty of gynecologic oncology.

SGO is working to have legislation introduced very soon in the House of Representatives to address this issue. The bill will implement a waiver of the budget neutrality rules for the new E/M code changes.

Once this legislation is introduced it will be very important for all SGO members to contact their U.S. Representative and two U.S. Senators to request support for the legislation and urge congressional passage of the provisions before the new E/M code changes are implemented on Jan. 1. Please watch for SGO Legislative Action Alerts after the July 4 Holiday and take action when called upon to make these critical contacts with your lawmakers. The letter that was sent on June 18 to Speaker Pelosi and Leader McConnell from SGO and other medical and surgical specialty societies is available here.