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GOP Doctors Caucus Encourages CMS to Include Global Codes in 2021 E/M Adjustment

Yesterday, Reps. Phil Roe, MD (R-TN), Larry Bucshon, MD (R-IN), and Andy Harris, MD (R-MD), released the following statements after sending a bipartisan letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in opposition to a provision in the 2020 Medicare Physician Fee Schedule proposed rule not to increase the value of postoperative E/M visits that are bundled into 10- and 90-day global surgery codes. At the request of ASCRS and the surgical community, the letter was led by Reps. Bucshon and Ami Bera, MD (D-CA), and signed by 23 of their colleagues, including 13 members of the GOP Doctors Caucus.

“Under the physician fee schedule, CMS pays surgeons and other specialists a flat fee for services rendered, including all follow-up care within a 10- or 90-day timeframe. Unfortunately, the 2020 physician fee schedule seeks to adopt new evaluation and management (E/M) codes for stand-alone/outpatient services without also adjusting that portion of the global codes. This change would adversely impact many specialty providers, like OB/GYNs who provide maternity care, by unfairly forcing them to accept lower reimbursement rates than their peers. I hope Administrator Verma will reconsider these changes before the 2020 physician fee schedule is finalized,” said Rep. Roe.

“Patients’ access to high-quality care must be at the forefront of all healthcare policy decisions. While I’m pleased that CMS updated the standalone office/outpatient evaluation and management codes, I’m disappointed that they failed to also include updates to the global surgery codes. That is why I was happy to co-lead this letter to Administrator Verma, urging the administration to incorporate the adjustments proposed into the global surgery codes as well, so that specialty differentials are not created and patients continue to have access to the care they need,” said Rep. Bucshon.

“As a physician and co-chair of the GOP Doctors Caucus, I recognize the importance and value that our surgeons and other specialty providers bring to major surgeries, including brain tumor removal, heart surgery, joint replacements, and maternity care. That is why over 20 members of Congress are asking CMS to reconsider their proposed changes to the evaluation and management (E/M) codes, and provide fairness and parity to the CMS payment structure for our physicians,” said Rep. Harris.

As we have reported, in the 2020 Medicare Physician Fee Schedule (MPFS) proposed rule, CMS is proposing to increase the value of standalone E/M office visits beginning in 2021. However, the agency did not propose to increase the value of postoperative E/M visits that are bundled into 10- and 90-day global surgery codes. Arbitrarily adjusting some E/Ms but not others disrupts the relativity of the fee schedule and violates current law.

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