In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, published on Nov. 1, 2019, CMS finalized significant changes to evaluation and management (E/M) services that will result in a major redistribution of payments. The ACR, along with many other physician and non-physician providers, is highly concerned about the impact of these policy changes and will continue its efforts to either have CMS modify its proposal or work for Congressional intervention to mitigate these results.

Issued under the guise of “reducing administrative burden, improving payment rates and reflecting current clinical practice,” CMS is building on changes it finalized in the 2019 Medicare Physician Fee Schedule (MPFS) Final Rule that would adopt a new coding structure for the office/outpatient evaluation and management (E/M) codes. Primary care providers have long requested a re-balancing of the payment system to move payments away from specialty and highly technical and surgical services to provider services supporting chronic, complex patients in the office and outpatient setting. This battle used to be called “cognitive versus non-cognitive proceduralist” and has been embedded in the tensions inherent in the MPFS since its inception in the 1990s. CMS after CMS (and Congress after Congress) have all weighed in on this battle. And now, this CMS — with the backing of the White House — has made policy changes that will move significantly in the direction of a sizeable redistribution of payments.

What do these changes to the E/M codes mean to radiology? CMS has estimated the impact to radiology (including both professional and technical components) to amount to 8%, while our own analysis puts the number at a minimum of a 9% cut. IR, nuclear medicine, and radiation oncology will all face sizeable reductions. Surgical specialties and non-physician providers, such as physical therapy, will also be hit significantly. Any provider who does not bill for E/M services will be penalized by this policy change.

Analysis conducted by the Moran Company shows that increased valuation of E/M services would cost approximately $6 billion in a single year alone. The new add-on code, GPC1X, would add at least an additional $1.6 billion to the price tag of these changes. Due to the fact that the MPFS is based on the concept of “budget neutrality” — meaning that when a service is increased, a cut must take place somewhere else — non-E/M billing radiologists and other providers will have their payments reduced accordingly.

The ACR remains concerned about the sizable cuts this proposal will impose upon radiology and other medical providers who do not frequently bill E/M services, and it has submitted extensive comments to both CMS and its administrator, Seema Verma, asking them to rethink the E/M policy and to defer this issue to Congress due to the enormity of its impact on certain physician specialties. The ACR does not oppose a re-weighting, nor do we undervalue the importance of E/M services by physicians. We do, however, strongly object to the requirement that those who do not bill for these services be obligated to cover the cost of E/M payment increases. This is the argument we will take to Congress.

Ideally, we would like Congress to intervene in this physician payment battle — to ask Congress to allow the increases in the E/M valuations but not penalize non-E/M services. That is a big “ask” of a body that’s in the midst of a partisan election year with countless issues before them. It will require Congress to pay for the changes we’re requesting in the realm of tens of billions of dollars. We must be realistic about our chances to effect this policy, but we cannot stand back without doing everything we can to help shape a reasonable compromise. We will need the help of every member of the ACR as this debate continues.