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January 8, 2021

ALERT from Washington DC: CMS Final Rule for 2018 Medicare Physician Fee Schedule

As you may be aware, in the beginning of November CMS released its Final Rule for the Medicare Physician Fee Schedule. This federal document is more than 1,200 pages, and although there were many changes, below highlights the one aspect followed closely by ASA and NJSSA – a change in the number of base units that CMS has assigned to screening colonoscopy.
Please see the highlights below provided to us by ASA President James Grant:
  • The good news is, because of the work of our leaders, engaged physicians and staff, we were able to convince CMS not to change its process on updating one component of the overall fee schedule. That change would have decreased our ANESTHESIA conversion factor, and our success on this issue actually culminated with an INCREASE in the conversion factor.
  • That being said, the 2018 Anesthesia Conversion Factor increases from $22.0454 to $22.1887 (geographic adjustments pending), while the conversion factor for your non-anesthesia codes has gone up from $35.8887 to $35.9996.
  • The not-so-good news and of interest to many of us is that CMS decreased the base units for screening colonoscopy to 3 base units (00812).  ASA strongly disagrees with this decision. Our member survey data supports 4 units, and our Relative Value Guide (RVG) will reflect that. Differing values in the RVG and CMS are not common, but when we strongly disagree and we have survey data to support it, we will be transparent and make the appropriate notations in our RVG.
  • All the remaining GI endoscopy codes are 4 or greater, and because of the strong work by our economic advocacy team, the complexities of anesthesia for ERCP were recognized and affirm the recommendation of 6 units.
The process of assigning values to codes is very complex with multiple layers. Probably one of the key components are the surveys sent out to clinicians. If you should ever get a survey, please take the time to review it and give us appropriate and thoughtful responses. All the processes leading up to CMS valuation take the surveys very seriously and often are the major criteria in the code value assignment process.
For any additional information about codes for other procedures, particularly pain procedures, please click here.