ASCP Opposes E/M Proposal in Medicare Physician Fee Schedule

Publication Date: Sep 27, 2019

On September 26, ASCP submitted formal comments to the Centers for Medicare & Medicaid Services (CMS), opposing its proposal to restructure the Evaluation and Management (E/M) office visit codes. In this year’s Medicare Physician Fee Schedule PFS Proposed Rule, CMS proposed to revamp the coding structure and to significantly increase the payments for these services.

Because of the significant costs with this proposal—approximately $7 billion—the proposal triggers the revenue neutrality requirement, which requires offsetting cuts in payment amounts for those providers least poised to benefit from the payment increases. As pathologists do not typically bill for E/M services, the cuts for pathology—and to a lesser degree—clinical laboratories, are sizable. CMS estimates that cuts in pathology payments would be eight percent, while independent labs would see a four-percent cut in payments. ASCP stated that “without additional funding to reverse these projected cuts to pathologist and laboratory payments, we are opposed to the proposal.” CMS is proposing to adopt the proposal in CY 2021.

In our comments on the Proposed Rule, ASCP also raised concern about self-referral arrangements in response to a proposal to revise the Agency’s Advisory Opinion process on the application of Physician Self-Referral Law. ASCP also expressed doubt about whether CMS has the statutory authority to increase the use of bundling within the PFS, and recommended that the Agency work closely with the AMA CPT Editorial Panel and Relative Value System Update Committee (RUC) in coding and valuation of any bundled payments for the PFS. For a copy of the ASCP letter to CMS, click here.

Other articles in the October 2019 ePolicy News:

ASCP Delegation Meets with FDA on LDT Oversight
Fix PAMA, Don’t Change Laboratory Date of Service Rule, ASCP Urges CMS
Meaningful Participation Sought Under the QPP for Pathologists in 2020
CDC Coordinates Investigation, Offers Healthcare Provider Resources Regarding Lung Disease Associated with Vaping
ASCP Expands List of Choosing Wisely Recommendations
Choosing Wisely Champions Recognized for Reducing Unnecessary Testing

To read more articles from ePolicy News click here.

For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.