Tri-Society Alert: CMS Releases 2021 Medicare Physician Fee Schedule

On December 1st, CMS released the 2021 Medicare Part B final payment and policy changes. Key things to know about the 2021 Physician Fee Schedule:

  • The 2021 conversion factor is $32.4085, a decrease of almost $4 from last year. The GI societies joined a coalition of about 65 societies in a statement opposing CMS’ decision and urging Congress to intervene.
  • While office/outpatient E/M physician work values increase, this may not be reflected in payments for all E/M codes due to budget neutrality regulations.
  • Payment parity for in-person and phone E/M visits ends when the public health emergency (PHE) concludes. Note: CMS will reject E/M codes 99441-99443 after the PHE. Report new code G2252 for 11-20 minutes of medical discussion for audio-only discussion with Medicare patients.
  • No separate payment for new PPE code 99072; CMS to increase payment for individual PPE supplies instead.

Wins for GI:

  • Value of EGD (43239) and colonoscopy codes (45385) affirmed following review.
  • Major increases to GI scope equipment valuation finalized; scope video system equipment (ES031) to increase from $36,306 to $70,673 and suction machine (Gomco®) (EQ235) from $1,981 to $3,195, phased in over two years.
  • CMS finalized office/outpatient E/M coding changes that will decrease documentation burden.

2021 payment tables for GI and E/M services:
GI endoscopy payment changes 
E/M payment changes 
GI endoscopy work, practice expense and malpractice changes 
E/M work, practice and malpractice changes

CMS resources:
CMS fact sheet on the CY 2021 Physician Fee Schedule Final rule
CMS fact sheet and frequently asked questions on the CY 2021 Quality Payment Program final rule
CY 2021 Physician Fee Schedule and Quality Payment Program final rule text.

Important Bills Addressing Looming Medicare Cuts

From ACG Legislative and Public Policy Council Chair, James C. Hobley, MD, MSc, FACG

CMS Still Moving Forward with Medicare Cuts: We still need your advocacy help! Medicare physician payments are scheduled to be cut across most specialties in CY 2021 when increases to evaluation and management (E/M) services are implemented. GI procedures are scheduled to be cut roughly 10%.

Good news: There is a bill in Congress prevents these cuts for 2 years. The “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020” (H.R. 8702) was introduced by Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN).

ACG Urging Congress to Forgo Medicare Sequestration Cuts: ACG joined a coalition of societies urging Congress to extend a moratorium on Medicare reimbursement cuts for as long as the COVID-19 public health emergency continues, warning that the pandemic is already straining providers’ finances. Congress, in its first coronavirus aid package, suspended a planned 2% Medicare pay cut through the end of the year. However, that reduction is set to take effect in January 2021 unless lawmakers opt to extend the moratorium.

Good news: H.R. 8840 was introduced by Rep. Brad Schneider (D-IL) and Rep. David McKinley R-WV). This bill suspends the aforementioned 2% Medicare “sequestration” payment cut until the end of the Public Health Emergency (PHE).

Progress on COVID-19 Relief Package as Congress Grapples with Appropriations Deadline: On Tuesday, December 1, the Congressional “Problem Solvers” Caucus led by Reps. Josh Gottheimer (D-NJ), Tom Reed (R-NY), Dusty Johnson (R-SD), Dean Phillips (D-MN), Abigail Spanberger (D-VA), and Fred Upton (R-MI) and Senators Joe Manchin (D-WV), Susan Collins (R-ME), Mark Warner (D-VA), Lisa Murkowski (R-AK), Jeanne Shaheen (D-NH), Mitt Romney (R-UT), Angus King (I-ME), and Bill Cassidy, MD, FACG (R-LA) announced a bipartisan, bicameral COVID-19 relief package. It is roughly twice as large as the amount previously put on the table by Senate Majority Leader McConnell, and its prospects remain uncertain. Please find the funding framework below. It is roughly twice as large as the amount previously put on the table by Senate Majority Leader McConnell, and its prospects remain uncertain but both House and Senate leadership conveyed that there was progress in talks.

This renewed push for a COVID-19 relief package is complicating the $1.4 trillion spending deal Congress is also trying to pass to keep the federal government open past December 11, 2021.

2020 MIPS Hardship Exemption Still Available: CMS also recently announced that the MIPS "Extreme and Uncontrollable Circumstances" Application was recently extended until February 1, 2021. It was previously open until December 31, 2020. The “Extreme and Uncontrollable Circumstances” policy allows MIPS eligible clinicians, groups, and virtual groups to submit an application requesting a reweighting of one or more MIPS performance categories to 0%. Submit an application now and be sure to cite COVID-19 as the reason for your application. If approved, you can still receive scores for the Quality, Improvement Activities, and Promoting Interoperability MIPS performance categories. Please note that if the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. Learn more in the 2020 Exceptions Applications Fact Sheet.

Stark Law and AKS Changes Released: Last month, the Department of Health and Human Services (HHS) published the anticipated regulatory changes to the Stark Law and Anti-Kickback Statute (AKS). The Stark Law final rule creates permanent exceptions for value-based arrangements. The exceptions also apply to arrangements treating non-Medicare patients. Complimenting these Stark changes, the AKS final rule implements new and modifies existing safe harbors to foster and protect value-based arrangements. Please find ACG’s policy snapshots below highlighting some of these important changes. Click here for the Stark Law final rule and fact sheet. Click here for AKS final rule and fact sheet.

ACG Practice Management Summit Registration is Still Open: Free On-Demand Session Below!

One benefit of the 2020 ACG Virtual Annual Meeting is that the registration is still open until December 31, 2020 and access to the platform is open until January 31, 2021!

There is still time to learn more about the hottest practice management and reimbursement issues impacting GI today and in the future. The Practice Management Summit offers new and innovative ways to improve patient care, improve operations, enhance productivity, and overall success in your careers. Register today and access the Practice Management Summit at ACG: Something for Everyone.

Free On-Demand Session! Check out this free on-demand session from this year's course. David J. Hass, MD, FACG, discusses strategies to compensate staff for those non-revenue generating, but essential, activities.

ACG at AMA House of Delegates Meeting

March Seabrook, MD, FACG and Bruce Cameron, MD, FACG recently represented ACG at the 2020 American Medical Association’s House of Delegates Meeting (HOD), where the state and national medical associations convene to help develop the public policy priorities for the AMA. Among the important topics discussed were patient copay accumulators, prior authorization, and the future of the ACA, as well as other important policy issues. Click here for the highlights from the 2020 AMA HOD meeting.

Thank you Drs. Seabrook and Cameron for representing clinical GI and patients.