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Action Alerts

Urge Your Member of Congress to Support CMS' Changes to E/M Payments

In the recent Physician Fee Schedule (PFS) final rule, the Centers for Medicare & Medicaid Services (CMS) finalized the first significant changes to the documentation requirements and payment of outpatient evaluation and management (E/M) services. These changes will better recognize the complex care American Society of Hematology (ASH) members deliver to their patients. This is a major advocacy victory for ASH and our work with the Cognitive Care Alliance as this has been a significant part of our advocacy agenda for the last decade. The Cognitive Care Alliance is comprised of medical specialty societies that have united in support of changes to the E/M code families. 

The agency began exploring changes to the outpatient E/M codes in the CY 2019 rulemaking and had finalized a single payment for level 2 through 4 E/M services. Physician specialties were united in their opposition to this policy. In response, the AMA CPT Editorial Panel revised the E/M code definitions and documentation requirements and the RUC recommended values for the family.

In the CY 2020 Final Rule, CMS chose to adopt the code revisions made by the CPT Editorial Panel and the RUC values. The agency also finalized a single complexity add-on code, GPC1X that physicians can bill for the work associated with ongoing, comprehensive primary care and/or visits that are part of ongoing care related to a patient’s single, serious, or complex chronic condition. The agency chose not to include the new E/M values in the 10- and 90-day global periods.

There are a number of stakeholders who are opposed to all or parts of this policy and are actively advocating either to have it changed or eliminated. Because this policy is not scheduled to take effect until CY 2021, CMS will have an opportunity to make additional changes in next year’s PFS. It is critical for ASH members to take action now to ensure the final policy is implemented without change!

Please urge your Members of Congress to contact CMS to express their support for the CY 2020 payment changes. They address the longstanding payment inaccuracies in the PFS and are a first step towards appropriately recognizing the care ASH members deliver to patients.

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