CMS released on July 8 the 2016 Medicare Physician Fee Schedule (MPFS) proposed rule which, if finalized, would drastically cut reimbursement rates for colonoscopy and other lower GI endoscopy procedures. Though ACG and GI societies were successful in getting a one-year delay in the revaluation of lower GI endoscopy procedures, these proposed cuts, if finalized, would be effective January 1, 2016.
Proposed Colonoscopy Reimbursement Rates for 2016
ACG and the GI societies are committed to fighting these cuts. We are scheduled to meet with CMS leadership next week. ACG continues to urge members of Congress to help oppose these cuts as well as cosponsor the SCREEN Act (S. 1079; HR 2035), which would maintain colonoscopy reimbursement at the 2015 levels and until the Medicare fee for service reimbursement system changes take place beginning in 2019. The SCREEN Act is currently the only legislation that deals with these changes to colonoscopy reimbursement.
ACG wants to share with CMS officials next week data on how cuts of up to 19 percent will affect GI practices. Please take the time and complete this quick poll and help us fight for fair reimbursement for you.
Proposed ASC Rule Includes Increases in Facility Fees for Upper GI Procedures
The Centers for Medicare and Medicaid Services (CMS) released the proposed rule that includes policy and payment changes for the Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers (ASC) for calendar year (CY) 2016.
Some highlights of the proposed rule:
- CMS proposes to increase facility fees for common procedures such as EGD, ERCP, and Esophagoscopy by 4 percent on average. However, ASC facility fees are scheduled to decrease by 2 percent for nearly all colonoscopy codes.
- CMS is proposing a major reorganization of all APCs resulting in the restructuring and consolidation of the APCs that contain GI procedures from 23 APCs to 13 APCs. In the proposed rule, CMS states the proposed APC groupings would more accurately accommodate and align new services within clinical APCs with similar resource costs.
- Upon initial review of the restructured APCs, reimbursement for EGD codes would increase 3 percent, on average. The colonoscopy codes would be decreased approximately 3 percent.
- The GI societies have advocated for the APC reassignment of four lower endoscopy stent procedures. CMS is proposing to accept our recommendation and plans to move CPT codes 44384 (Ileoscopy with stent), 44402 (C-stoma with stent), 45347 (Flex sig with stent) and 45389 (Colonoscopy with stent) to APC 5331 (Complex GI Procedures), resulting in payment increases for these services.
- ASCs are subject to a 2 percent reduction in their annual payment if they fail to meet the requirements of the ASCQR Program. The calendar year (CY) 2018 ASCQR Program measure set includes 12 measures — 11 required and one voluntary. CMS is not proposing to add any new measures to the program in this proposed rule.
These changes, if finalized, would be effective January 1, 2016.
Carroll D. Koscheski, MD, FACG, ACG National Affairs Committee Chair
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