April 23, 2020

ACR Seeks to Reverse Negative Effects of Medicare E/M Code Revaluation

The American College of Radiology® (ACR®) is the driving force, in a collaboration with other physician societies, to avoid significant reductions in Medicare reimbursement for specialty physicians from the planned implementation of revalued evaluation and management (E/M) codes.

The Centers for Medicare and Medicaid Services (CMS) adopted plans for the now impending E/M code revaluation in November 2019 as part of its 2020 Medicare Fee Schedule (MPFS) Final Rule. These modifications are scheduled for implementation on Jan. 1, 2021.

The MPFS is federally required to maintain budget neutrality. Therefore, the increase for E/M codes must be offset by a reduction in other areas of the fee schedule. Radiologists and other providers who rarely, if ever, bill E/M due to the nature of their specialties are facing significant across-the-board Medicare reimbursement reductions as a result.

In response, the ACR led a coalition of 45 physician and non-physician provider organizations April 17 in sending a letter to Congressional leaders urging Congress to waive budget neutrality for the new E/M policy. The action would allow those who frequently bill E/M to retain the reimbursement increases without the need to offset those increases in other parts of the fee schedule.

This request has been echoed in separate letters to Congress by the American Medical Association and the American College of Physicians. Including a budget neutrality waiver in one of the future COVID-19-related spending packages would avoid adding significant reimbursement cuts to physician practices that are already facing devastating financial impacts from the pandemic.

The current public health emergency related to COVID-19 has had a detrimental impact on the health care delivery system, with physicians and other providers facing serious short- and long-term decisions regarding their practices. Waiving budget neutrality associated with the impending E/M implementation would help practices facing those difficult decisions.

The ACR will continue to advocate for policies that ensure radiologists can continue to ensure optimal patient care, both now and in the future.