Congress Reduces and Delays Medicare Provider Payment Cuts

As a result of tireless advocacy by an American College of Radiology® (ACR®)-led medical coalition representing more than one million providers, the Consolidated Appropriations Act, 2021 (Omnibus and Coronavirus Relief Bill), passed by Congress on Dec. 21, includes a significant reduction in anticipated Medicare provider payment cuts due to evaluation and management (E/M) coding changes and a phased-in implementation of these E/M adjustments. 

The ACR Government Relations team is continuing to monitor any messaging from the White House regarding the timeline for the President to sign the bill in to law. Any additional information will be shared when/if it becomes available. The ACR and its coalition partners will to continue to address Medicare cuts with the Centers for Medicare & Medicaid Services (CMS) and the new Congress.

ACR statement on Medicare payment cut reduction and delay in the Consolidated Appropriations Act


ACR Efforts to Counter Evaluation and Management (E/M) Coding Changes. Click the image to view a larger version.

Evaluation and Management Timeline medium size image

E/M News

ACR Supports “Holding Providers Harmless from Medicare Cuts During COVID-19 Act”
The American College of Radiology calls on Congress to pass the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 or ensure that the language is included in any larger bills passed during this Congress. This legislation would avert impending reimbursement cuts due to evaluation and management (E/M) code changes in the Medicare Physician Fee Schedule.

Congress Must Act to Stop Cuts Threatening Specialty Physicians
Howard B. Fleishon, MD, MMM, FACR, chair of the American College of Radiology Board of Chancellors, explains how ill-timed Medicare evaluation and management coding changes may force many physician practices, already reeling from COVID-19’s financial impact, out of business.

Congressman Rush Requests E/M Budget Neutrality Waiver
Rep. Bobby Rush (D-IL) and 92 House colleagues sent a bipartisan letter to House leadership asking for a two-year waiver of budget neutrality to be included in any relevant upcoming legislation to avert the impending reductions associated with implementing the Centers for Medicare and Medicaid Services (CMS) 2021 evaluation and management (E/M) policy.

Modern Healthcare: ACR Calls Payment Cuts Due to Medicare E/M Changes “Unacceptable”
In a recent Modern Healthcare article, ACR called these E/M cuts “unacceptable” and warned that "An 11 percent across-the-board cut will seriously threaten radiology's ability to ensure patients have access to the high quality of care they rightfully deserve." (Subscription may be required)

ACR Resources

These resources are for background purposes. The ACR will issue updated impact tables and summaries on the Medicare cuts provisions in the newly passed bill in the coming days.

MPFS Impact Tables at the Code Level
ACR® impact tables show the payment rates for radiology and radiation oncology services for CY 2020 compared to the 2021 proposed rates. One of the main factors contributing to the decrease is the decrease in the conversion factor to maintain budget neutrality due to updates to the office/outpatient E/M services for 2021.

ACR Provides Detailed Radiology-Specific Summary of the MPFS Proposed Rule
CMS reiterated its decision in the 2020 final rule to move forward with adoption of a new coding structure for the office/outpatient E/M codes as recommended by the American Medical Association (AMA) and the associated increased valuations of these E/M services.