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E/M comments may fall on deaf ears at CMS


 

Doctors’ dismay at the proposed flattening of evaluation and management (E/M) payments seems to be falling on deaf ears.

More than 170 medical societies and organizations expressed their concern about the new payment structure for E/M codes proposed as part of the 2019 Medicare Physician Fee Schedule (PFS) in comments on the draft rule.

Yet, in the final days of the comment period, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, took to Twitter to defend her agency’s plan.

The controversial proposal would set the payment rate for a level 1 E/M office visit for a new patient at $44, down from the current $45. Payment for levels 2-5 would be $135. Currently, payments for level 2 new patient visits are set at $76, level 3 at $110, level 4 at $167, and level 5 at $211.

For E/M office visits with established patients, the proposed rate would be $24 for level 1, up from the current $22. Payment for levels 2-5 would be $93. Under the current methodology, payments for established patient level 2 visits are set at $45, level 3 at $74, level 4 at $109, and level 5 at $148.

Offsetting the changes in payment are several new proposed add-on codes, according to CMS.

Despite the lower payment for more complex patient care, Ms. Verma touted the scheme’s budget neutrality.

Ms. Verma’s tweets come as medical societies filed their formal complaints on the proposal, mirroring concerns expressed in two letters sent to the agency ahead of the comment deadline. The letters, sent at the end of August and between the two of them signed by more than 170 medical associations, aimed to preempt the comment process. They called for the E/M proposal to be rescinded, claiming that the cuts would reduce access to Medicare services by patients and hurt physicians that treat the sickest patients and those who provide comprehensive primary care because the expected lower reimbursement. One suggested that the changes exacerbate workforce shortages.

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