As we alerted you late last week, CMS released its 2020 Medicare Physician Fee Schedule final rule and finalized its proposal to increase the value of standalone E/M services but did not increase the value of post-operative E/M services included in 10- and 90-day global codes. ASCRS, the AMA, and the surgical community had advocated that CMS should extend the increased values of E/M codes to the globals because failing to do so would disrupt the relativity of the physician fee schedule; create illegal specialty differentials; and run afoul of the MACRA statute that requires CMS to study the value of global services, but continue to update codes that are revalued. In addition, we argued that the previous instances when E/M codes were revalued, CMS increased the post-operative values in the global codes. Despite this advocacy, bipartisan letters from Congress, a meeting with CMS, and a letter to CMS with more than 50 organizations including the AMA—CMS did not increase the global code values in the final rule. CMS indicated it is continuing to evaluate the global codes. Because the updates to E/M services are not effective until 2021, ASCRS and the surgical coalition will continue to advocate that the increases to the globals be made before that time. We are currently considering our options and will keep you updated.
While an update to the post-operative E/M services included in global codes will increase the value of these surgical codes, it is important to consider the overall impact of increased E/M services—whether from only the standalone codes or from standalone and if the values are increased in global codes—on the physician fee schedule (PFS). Because the PFS is budget neutral, and E/M services are the most frequently billed services, there will be a significant redistribution of value across the PFS in 2021. In addition, CMS finalized a chronic condition add-on code that will further redistribute value. While CMS has not detailed what specific actions it would take to preserve budget neutrality, it is likely that the conversion factor will be impacted negatively, or CMS could make additional across-the-board reductions. We will keep you updated.