Joint Society Statement: Disappointing Medicare Cuts Threaten GI Practice

The Centers for Medicare and Medicaid Services (CMS) have released proposed payment rules for physician services and facility fees for calendar year 2024. The GI societies are disappointed and concerned to see a proposed cut to reimbursement. Watch for alerts on our advocacy efforts and how you can help. The proposed rules also included positive news, including increased facility fees, new codes to increase health equity, and telemedicine reimbursement.
 
Six takeaways for GI
 
  • Cuts to physician payments: The CY 2024 Physician Conversion Factor (CF) is $32.75. This will result in a decrease of 3.36% in GI payment rates from this year’s $33.89. Note this is the proposed rule and the GI societies will advocate for increased rates before CMS finalizes the rule this fall. 
  • Increased facility fees: CMS proposes a 2.8% increase in facility payment rates overall, and we are happy to report GI increases are estimated to be about 6-8% higher than current rates.
  • New codes to increase health equity: CMS proposes new codes and payment for several new services to help underserved populations. We applaud the Administration’s commitment to advance health equity and expand access to critical medical services. 
  • Telemedicine payments continue: In a positive move, CMS proposes several provisions including allowing telehealth visits to originate at any site in the U.S. (e.g., individual’s home), payment for audio-only services, and permanently including Social Determinants of Health Risk Assessments. 
  • No changes to split/shared visits policy: We’re also glad CMS proposes to delay through at least Dec. 31, 2024, the implementation of the definition of the “substantive portion” as more than half of the total time with the patient. Facilities can continue to use either one of the three key components (history, exam, or medical decision making) or more than half of the total time spent to determine who will bill for the visit. 
  • Proposed changes to colonoscopy interval measure for ASCs: Appropriately, CMS proposes to modify quality reporting program measures to align with the minimum age requirement for CRC screening in clinical guidelines.
 
For more information, see the GI societies’ summaries: Medicare Physician Fee Schedule (MPFS) and Medicare Hospital Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC).
 
CY 2024 Medicare Proposed Physician Payment Charts
2024 Proposed Medicare Physician Payments
2024 Proposed Medicare Relative Value Unit Changes
 
CMS Medicare Physician Fee Schedule Proposed Rule and Fact Sheets
2024 Medicare Physician Fee Schedule Proposed Rule
2024 Medicare Physician Fee Schedule Proposed Rule Fact Sheet
 
CY 2024 Medicare Proposed Hospital Outpatient and ASC Payment Charts
2024 Proposed Medicare Hospital Outpatient Payments
2024 Proposed Medicare Hospital Outpatient Payments for Top 10 GI codes
2024 Proposed Medicare ASC Payments
2024 Proposed Medicare ASC Payments for Top 10 GI codes
 
CMS Hospital Outpatient and ASC Proposed Rule and Fact Sheets
2024 Medicare OPPS/ASC Proposed Rule
2024 Medicare OPPS/ASC Fact Sheet

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 almost 16,000 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 Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

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Media Contact

Andrea Lee
Director of Marketing and Communications
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ALee@asge.org