This Week – November 15, 2014

This Week in Washington DC:

  1. Summary: Medicare Releases 2015 Physician Fee Schedule Payment Rule

2015 Medicare Payment Rule Good News: Revaluation of Colonoscopy Codes Delayed

CMS has released the calendar year (CY) 2015 Medicare Physician Fee Schedule (PFS) Final Rule, including a delay in the valuation of lower GI codes until CY2016, as requested by the three GI societies.

ACG and the GI societies have developed a summary of key provisions in the final rule to help GI practices prepare for the payment and policy changes that take effect January 1, 2015. Highlights of the rule include:

  • Delay in the Revaluation of Colonoscopy: The 2015 PFS final rule delays the revaluation of colonoscopy and the lower GI endoscopy codes. Due to budget neutrality adjustments and other system-wide physician payment changes in 2015, the PFS payment rates may change slightly from 2014. We will keep you updated on these changes.
  • GI Code-Specific Issues: In the 2015 final rule, CMS nominally increased the physician work values for several upper GI endoscopy codes.

    ACG Member Note: There are numerous errors to the physician work values posted by CMS, and thus, to the projected 2015 Medicare reimbursement rates for upper GI endoscopy codes. CMS is working to correct these posted values and ACG will update the membership as soon as possible.

  • Use of Temporary Medicare G-Codes in New Rate-Setting Process: CMS finalized the use of temporary G-codes to facilitate continued payment for new or modified CPT codes.
  • CMS Changes Definition of CRC Screening Tests: CMS has modified, effective Jan. 1, 2015, the definition of “colorectal cancer screening tests” to include anesthesia that is furnished in conjunction with screening colonoscopies. The effect of changing the definition is an extension of the waiver of beneficiary coinsurance and deductible for anesthesia or sedation services furnished in conjunction with a screening colonoscopy.
  • Physician Payment Update: Legislation delaying implementation of the sustainable growth rate formula (SGR) is set to expire on March 31, 2015, without Congressional intervention, when physician payments would be cut about 21 percent. The GI societies and CMS support legislation to repeal the SGR and reform the physician payment system in a manner that provides more stability for Medicare beneficiaries and providers while promoting efficient, high-quality care.

Read more about these and other changes in the summary prepared by the GI societies.

ACG and the GI societies will continue to work together to advocate on reimbursement issues, as well as to work with CMS in 2015 as the agency determines the 2016 payment rates for GI procedures.

Please stay tuned for further updates. Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, go to and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway