Released on Nov 2, 2018

GI Codes to Be Revalued after CMS Sides with Anthem; E/M Payment Changes Delayed

Late yesterday, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule, which includes several significant policy and payment changes that are expected to impact gastroenterologists beginning in CY 2021.

Most significantly, CMS will revalue colonoscopy with snare (45385) and EGD with biopsy (43239), which may impact these code families. In an unprecedented and disturbing development, both services were nominated as potentially misvalued by Anthem, a major player in the U.S. health insurance market. This is the first time a private payor has nominated CPT codes via the potentially misvalued codes process.

The Agency also finalized many of the proposed Evaluation and Management (E/M) coding, documentation and payment changes, but delayed their implementation until January 1, 2021. Stay tuned for a call to action on these issues.

ACG, AGA and ASGE are reviewing the final rule and will provide a detailed analysis. Read a topline summary of the GI codes revaluation and E/M components of the rule.

Review the fact sheets for the CY 2019 Physician Fee Schedule and the Quality Payment Program final rule. 


About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.

American Society for Gastrointestinal Endoscopy
3300 Woodcreek Drive Downers Grove, IL 60515
P (630) 573-0600
F (630) 963-8332
 www.asge.org
 www.screen4coloncancer.org

Media Contact

Gina Steiner
Director of Communications
630.570.5635;gsteiner@asge.org