Medicare Physician Fee Schedule Rule Mixed, But Trouble Lies Ahead

On November 1, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Physician Fee Schedule Final Rule for CY 2020, which fortunately does not include major cuts for overall payments for pathology services. That said, CMS is continuing to pursue changes to the Medicare Evaluation and Management Codes that could result in sizable cuts (about eight percent) for pathology payments in CY 2021.

For CY 2020, CMS is estimating that there will be no substantive change (0%) in overall payments for pathology services, though clinical laboratories are expected to see a slight increase (+1%). ASCP, working in concert with the College of American Pathologists, helped defend pathology service payments from cuts proposed by CMS. These efforts helped prevent erosion in the payment rates for several key pathology services.

The biggest concern posed in this year’s Final Rule concerns the CY 2021 payment rates for pathology services. CMS has proposed updating the codes and payment rate policies associated with the Medicare Evaluation and Management (E/M) Services. Interestingly, CMS has increased payment rates for these services that exceeded the AMA Relative Value Scale Update Committee’s recommendations for valuing these services. As ASCP outlined in an earlier ePolicy story, because the proposal would trigger Medicare’s revenue neutrality limitation, the costs of increasing payment rates for E/M services are borne by those providers, such as pathologists, that tend not to bill for these services.

ASCP will be working with the CAP and other stakeholders in opposition to the proposal as part of our advocacy on the Final Rule. Click here for a copy of ASCP’s comments on the proposed rule.

Other articles in the November 2019 ePolicy News:

• ASCP and the BOC Advocate for Better CLIA Personnel Standards
• ASCP Scores Major Victory with CMS on Laboratory Date of Service Policy
• ASCP Pushes CMS to Improve PFS QPP Rule for Pathologists
• Concerns About NGS Coverage Resonate with CMS
• ASCP Continues Patient Advocacy Efforts on Surprise Billing Legislation
• CMS Fails to Close Pathology Loophole in Self-Referral Rules

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.