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Released on Dec 3, 2020

TAKE ACTION: Medicare plans significant payment cuts for 2021

CMS just finalized policy and payment regulations that take effect Jan. 1, 2021. Cuts to physicians are deep — GI reimbursement could drop 4%.

Congressional action is our last option. The GI societies joined a coalition of about 65 societies in a statement opposing CMS’ decision and urging Congress to intervene.

We need your help!

Tell Congress to pass the “Holding Providers Harmless from Medicare Cuts Act” (H.R. 8702), which provides a two-year reprieve while the GI societies and other specialties work toward a permanent resolution.

Key things to know about the 2021 Physician Fee Schedule:

·    The 2021 conversion factor is $32.4085, a decrease of almost $4 from last year; cuts to GI could be about 4 percent, depending on your practice’s mix of services.

·    While office/outpatient E/M physician work values increase, this may not be reflected in payments for all E/M codes due to budget neutrality regulations.

·    Payment parity for in-person and phone E/M visits ends when the public health emergency (PHE) concludes. Note: CMS will reject E/M codes 99441-99443 after the PHE. Report new code G2252 for 11-20 minutes of medical discussion for audio-only discussion with Medicare patients.

·    No separate payment for new PPE code 99072; CMS to increase payment for individual PPE supplies instead.

Wins for GI:

·    Value of EGD (43239) and colonoscopy codes (45385) affirmed following review.

·    Major increases to GI scope equipment valuation finalized; scope video system equipment (ES031) to increase from $36,306 to $70,673 and suction machine (Gomco®) (EQ235) from $1,981 to $3,195, phased in over two years.

·    CMS finalized office/outpatient E/M coding changes that will decrease documentation burden.

Summary of cuts by specialty:

 

 

Stay tuned for more information on how you can help us stop the cuts to physician payments.

2021 payment tables for GI and E/M services:

·    GI endoscopy payment changes 

·    E/M payment changes 

·    GI endoscopy work, practice expense and malpractice changes 

·    E/M work, practice and malpractice changes

CMS resources:

 

CMS fact sheet on the CY 2021 Physician Fee Schedule Final rule

CMS fact sheet and frequently asked questions on the CY 2021 Quality Payment Program final rule

CY 2021 Physician Fee Schedule and Quality Payment Program final rule text