GI Societies Will Urge Congress to Reverse Cuts – You Can Help! 

The final 2024 Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) rules were released on Nov. 2. 

Key Takeaways for GI

  • Physician payments decline: The GI societies will urge Congress to reverse the 3.37 percent cut to Medicare physician reimbursement announced in the 2024 fee schedule. This cut is based on a physician conversion factor of $32.74 (in 2023 the rate is $33.89). Medicare payments already fail to keep up with the increasing cost of delivering healthcare. More cuts only exacerbate that problem. 

  • Hospital and ASC payments increase: Conversion factors increase 3.1 percent to $87.38 for hospitals and $53.51 for ASCs that meet applicable quality reporting requirements.

  • Telemedicine coverage extended through at least 2024: CMS finalized several telemedicine provisions, including allowing telehealth visits to originate at any site in the U.S. (e.g., individual’s home), payment for audio-only services, and permanently including Social Determinants of Health Risk Assessments. CMS will continue covering telemedicine through 2024 with payment rates matching those of office/outpatient E/M visits. While many of the telehealth COVID-19 flexibilities are in place until the end of 2024, Congress and CMS are working toward establishing permanent policies for 2025 and beyond. The GI societies are actively participating in these policy discussions to ensure long-term access to telehealth services for your patients.

  • CMS conforms to CPT split/shared visits guidelines: In good news for facilities, CMS finalized a revision to its definition of “substantive portion” of a split/shared visit to conform to the current procedural terminology (CPT) guidelines, This means that for Medicare billing purposes, the definition of “substantive portion” means more than half of the total time spent by the physician and non-physician practitioner performing the split/shared visit, or a substantive part of the medical decision making as defined by CPT. This responds to public comments asking that CMS allow either time or medical decision making to serve as the substantive portion of a split/shared visit.

  • New codes to increase health equity: CMS established several new services to help underserved populations. For the first time, CMS will pay for caregiver training services. CMS is also establishing payment for community health integration services, principal illness navigation services and for social determinants health risk assessments that can be reported with certain services, including E/M visits. We applaud the administration’s commitment to advance health equity and expand access to critical medical services. 

Take Action Now

ACG staff will be on Capitol Hill beginning next week to urge lawmakers to avert the cuts. Congress needs to know Medicare payments already fail to keep up with the increasing costs of delivering healthcare.

Previously, ACG joined a coalition of healthcare groups in signing a letter to support H.R. 2474, which would tie annual reimbursement updates to the MEI. More recently, ACG joined 121 national medical specialty societies in thanking GOP Doctors Caucus Co-Chairs for their draft legislation to reform budget neutrality policies in the Medicare Physician Fee Schedule.

Now, you can help, too. In five minutes, use this advocacy tool to tell your Members of Congress about the reforms the Medicare reimbursement system desperately needs:


Resources

2024 Physician Fee Schedule Final Rule 

2024 Physician Fee Schedule Final Rule Press Release

2024 Physician Fee Schedule Final Rule Fact Sheet

2024 OPPS/ASC Payment System Final Rule

2024 OPPS/ASC Payment System Final Rule Fact Sheet

2024 Final Rule ASC Payment Rates

2024 Final Rule ASC Top 10 Base and Biopsy Codes

2024 Final Hospital Outpatient Payment Rates

2024 Final Rule Hospital Outpatient Top 10 Base and Biopsy Codes