COVID Relief Bill Mitigates Scheduled Cuts to Surgical Payment

On December 21, 2020, Congress enacted a 5,500-page consolidated appropriations act, which included COVID relief provisions. Through 2020, The American Society of Breast Surgeons (ASBrS) has worked to avert the Fee Schedule cuts to surgical payments that were set to take effect on January 1, 2021. The Society joined 11 other surgical professional associations in forming the Surgical Care Coalition to advocate for preventing Medicare payment cuts that threaten patients' timely access to surgical care.

As explained below, we believe that the combination of various provisions in the relief legislation passed yesterday accomplishes that goal.

Add-on Code Delayed for Three Years

The legislation directs CMS not to make payment for G2211 before January 1, 2024, which places a three-year delay on CMS' ability to implement the new add-on code G2211. This add-on code was a large driver of the budget neutrality Fee Schedule cuts. In fact, delaying the implementation of G2211 alone eliminates approximately 35% of the scheduled cut to general surgical services for 2021.

3.75% "Boost" to Entire Fee Schedule

The legislation infuses at least three billion dollars into the Fee Schedule, with the goal of giving all services a 3.75% increase, across the board. The legislation does not specify how this must be accomplished, so CMS will have to determine the operational mechanics.

Sequestration Moratorium Extended

In the CARES Act, Congress imposed a temporary moratorium on sequestration, which has collected an automatic 2% cut from all Medicare providers since 2013. The moratorium began on May 1, 2020 and was set to expire on December 31, 2020, but given the ongoing pandemic, this legislation extends that moratorium through March 31, 2021. Thus, the 2% Medicare cut will not be applied in Q1 2021.

APM Threshold

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implemented an incentive payment for participation in certain alternative payment models (APMs).  To be eligible for the incentive payment, the law mandates that a certain threshold of services be delivered in the context of the APM, and those thresholds were mandated by law to increase over time. This provision prevents a steep increase to that threshold slated for 2020 performance (for application to 2022 payments) whereby participants would have needed to perform over 75% of their services in an APM to be eligible for the incentive payment. This legislation leaves that threshold at 50% through CY 2022 performance (for CY 2024 payments).

Overall, this combination of policies will likely avert the scheduled cuts to surgical services and, for some services, even result in payment increases. CMS will issue an updated CY 2021 Fee Schedule to accommodate these legislative changes.

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