Whitfield L. Knapple, MD, FACG Chair, ACG National Affairs
Whitfield L. Knapple, MD, FACG
Chair, ACG National Affairs

This week, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Medicare facility fees for the hospital outpatient department (HOPD) and ambulatory surgical center (ASC), as well as the 2017 Medicare Physician Fee Schedule final rule.  ACG, AGA and ASGE alerted members when these rules came out and are currently reviewing the details.  Stay tuned for a more extensive summary.

Some highlights from the GI societies’ alerts:

Moderate sedation:  CMS is removing the value of performing “moderate sedation” in many GI endoscopy codes, thereby reducing the value of the underlying procedural codes.  There will be no financial impact for ACG members who perform their own moderate sedation.  If you administer moderate sedation, you will now report two codes instead of one beginning January 2017: the procedure code and this new moderate sedation code.  ACG members who use anesthesia professionals, however, will see a small cut in reimbursement for these codes.  CMS reduced the value of these codes by .10 RVUs.  The reduction is less onerous than recommended by the AMA Relative Value Update Committee (RUC), and as well as the value taken out of all other specialty codes with moderate sedation previously considered inherent to the procedure (.25 RVUs for all other specialties).  ACG recognizes your frustration and appreciates the real world implications.   ACG is also committed to work tirelessly on your behalf to represent the best interests of clinical GI.

Ambulatory Payment Classification (APC) Adjustments: CMS finalized some changes to APCs impacting GI for CY 2017.  APCs are a group of similar GI services performed in the hospital outpatient setting that are paid at a single facility fee rate.

Site Neutral Payments:  Congress required CMS to level the payment rates for some services in off-campus hospital outpatient departments. Currently, Medicare pays for the same services at a higher rate if those services are provided in a hospital outpatient department rather than a physician’s office or ASC.   Beginning January 2017, however, certain off-campus services will no longer be paid at the higher HOPD facility rate.

In the coming days, you will receive further guidance from ACG and the GI societies.

Whitfield L. Knapple

Chair, ACG National Affairs Committee