• Academy Joins Major Push by Surgical Specialties to Fight Unfair E/M Proposal


    The Academy is signing on to an effort led by the American College of Surgeons to stem an ongoing devaluation of surgical services under Medicare. The Centers for Medicare & Medicaid Services is proposing an inequitable overhaul of E/M codes, in which all non-E/M reimbursements would be reduced in 2021 to fund a global E/M code increase. CMS would not apply this adjustment to global surgical payments’ postoperative visits. 

    Our effort will fight this E/M proposal with the support of many in surgical medicine, since it would establish an unfair, two-tier system. 

    The Academy believes that without a corresponding change to surgical post-operative visits, the overhaul would deliver a 6-10% pay hit to surgical specialties. Our profession essentially would bear the brunt of the program’s budget neutrality. 

    CMS’ new E/M proposal is part of its draft 2020 physician fee schedule. The agency is accepting a plan put forward by the American Medical Association on guidelines and descriptors in order to place more emphasis on the time required. This replaces a replaces a previous overhaul of E/M codes in which the current five payment levels would be collapsed to just three. 

    Although this new plan would significantly increase E/M payments for patient visits in a budget-neutral manner, the change is not applied to post-operative surgical visits. The Academy believes this is an unacceptable omission. 

    If CMS can be convinced to apply its proposed E/M increase to postoperative visits, expected cuts to cataract and other ophthalmic surgery reimbursements would largely be negated when implemented in 2021. 

    Additionally, the Academy believes that CMS should make comparable increases to our profession’s eye visit codes.