CMS Releases Proposed Medicare Payment and Facility Fee Regulations

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

The ACG, AGA, and ASGE recently alerted membership on two important Medicare payment and policy regulations.

On July 13th, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) Proposed Rule. Of note, the CY 2022 proposed conversion factor will be reduced to $33.58, a $1.31 cut from CY 2021. This is due to changes to E/M and other services last year. Congress stepped in to avert the scheduled CY 2021 cuts. However, without congressional action, ACG members are again facing various incremental cuts in 2022. Together, these looming cuts are unwarranted and unacceptable. This week, ACG and a coalition of specialty societies urged Congress to prevent these reimbursement cuts in CY 2022. ACG will continue to advocate on behalf of clinical gastroenterology in opposition to these cuts.

Some other highlights from the tri-society alert:

  • Peroral endoscopic myotomy (POEM) and colon capsule endoscopy will get new CPT codes and payments.
  • CMS will begin the transition of waiving cost-sharing when polyps are removed during a screening colonoscopy. Thank you ACG members for your advocacy efforts!
  • Effective Jan. 1, 2022, physician assistants can bill and be paid directly for their services. 
  • The Merit-Based Incentive Payment System (MIPS) will be revised and phased-out and will move towards the MIPS Value Pathways (MVPs) system beginning in 2023.
  • CMS is statutorily required to weigh the MIPS Cost and Quality performance categories equally beginning with the 2022 reporting year. As proposed, the 2022 MIPS performance category weights:
    • Quality: 30%
    • Cost: 30%
    • Promoting Interoperability: 25% (no change from 2021)
    • Improvement Activities: 15% (no change from 2021)

Proposed Payment Charts for GI
CY2022 Proposed Payment Changes for GI
CY 2022 Proposed RVU Changes for GI

Click here to read the ACG, AGA, and ASGE alert.

On July 19th, CMS released the CY 2022 Hospital Outpatient Prospective Payment System (OPPS)/ambulatory surgical center (ASC) Proposed Rule. Some highlights from the tri-society alert:

  • The conversion factors increase 2.3% to $84.46 for hospital outpatient departments and $50.04 for ASCs meeting the quality reporting requirements
  • GI procedure payments are expected to increase 3%

Payment Charts
CY 2022 Proposed ASC Payment Rates for Top GI Codes
CY 2022 Proposed ASC Payment Rates
CY 2022 Proposed HOPD Payment Rates for Top GI Codes
CY 2022 Proposed HOPD Payment Rates

Click here to read the ACG, AGA, and ASGE alert.

Member of Congress Spotlight: Rep. Diana Harshbarger (R-TN)

ACG is working closely with Rep. Diana Harshbarger (R-TN), supporting her legislation related to pharmacy benefit managers (PBMs). Rep. Harshbarger, a pharmacist by training, recently expressed concerns over PBMs' limiting access to low-volume bowel preparation products. Her legislation requires a review of PBM formulary restrictions, step therapy, and other prior authorization requirements that have been detrimental to patient care. Please urge your leaders in Washington D.C. to support Rep. Harshbarger's bill.

Contact Your ACG Governor Today

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.