Preventing Planned Cuts to Surgical Payments

2021 Medicare Physician Fee Schedule Proposed Rule Released

On August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2021. The proposed CY 2021 PFS conversion factor is $32.26, representing a significant decrease from the CY 2020 PFS conversion factor of $36.09. The CMS proposed conversion factor includes a budget neutrality adjustment to offset payment increases for office visits and other services.

CMS proposes to implement finalized CPT descriptors and payment rates for 2021, which will be a significant modification to the coding, documentation and payment of evaluation and management (E/M) services for office visits. However, CMS did not include E/M visits within the 10-day and 90-day surgical global surgical payment bundle in these updates.

The net result of these proposed changes is a -7% decrease in payment for general surgeons in 2021. The Society, along with its partners in the Surgical Care Coalition, is urging Congress to enact legislation to waive Medicare’s budget neutrality requirements for these E/M adjustments and to require CMS to apply the increased E/M adjustment to all 10- and 90-day global code values.

We urge all members to contact their legislators and ask them to support waiving budget neutrality and to require CMS to apply the proposed E/M modifications to visits within the surgical global period.

To easily locate your legislators’ contact information, visit: usa.gov/elected-officials

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