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Payment Policy Changes

As physicians continue to care for patients on the frontlines of the COVID-19 pandemic, cuts to physician payment for surgical services are looming. Finalized and recently proposed policies from the Centers for Medicare & Medicaid Services (CMS) conflict with current law and will have drastic consequences for Medicare patients seeking surgical services at a time when physician practices are struggling to stay afloat.

E/M Global Surgical Codes Changes

Finalized policies from the Centers for Medicare and Medicaid Services (CMS) will result in significant cuts to physician payment for most surgical services delivered to Medicare patients. This will destabilize health system financing and drastically diminish the opportunity for hospital and physician practices to recover financially from COVID-19. We need your help calling on Congress to take immediate action to stop the proposed 5% cut to orthopaedics and require CMS to apply the increased E/M adjustment to 10- and 90-day global code values. 

Write your representative today and ask them to sign a letter led by Rep. Ami Bera, MD (D-CA-07), and Rep. Larry Bucshon, MD, FACS (R-IN-08), to prevent cuts to Medicare payment for surgical services.

Cuts to Musculoskeletal Care Services

In the CY 2021 Medicare Physician Fee Schedule (PFS) rule, CMS has proposed to follow through with two major funding cuts for orthopaedic surgery. The proposed physician conversion factor is $32.26, an 11% reduction from 2020. In addition, CMS has proposed to accept the AMA-RUC recommendations to decrease the work relative value units (RVUs) for hip and knee arthroplasty CPT codes 27130 & 27447 from 20.72 to 19.60. If finalized, these changes will have a severe and lasting impact on access to care for America’s seniors.

Ask CMS to maintain current funding levels. The agency should accept the data provided by the AAOS and the American Association of Hip and Knee Surgeons (AAHKS), which demonstrates increased surgeon time spent on evaluation activities related to value-based care.