CMS proposes cutting Medicare payments for some specialty surgeries 6%-9%

CMS released its Medicare Physician Fee Schedule proposed rule for 2021 Aug. 3, which made several drastic cuts to payment rates for both general and specialty surgeons. 

What you should know:

1. The rule would drop the conversion factor by $3.83 to $32.26. The current conversion factor is $36.09.

2. General surgeons will see their Medicare reimbursement rates cut by 7 percent under the proposed rule. 

3. The following specialties will see the biggest impacts to their reimbursement rates:

  • Cardiovascular surgeons: 9 percent
  • Thoracic surgeons: 8 percent
  • Vascular surgeons: 7 percent
  • Neurosurgeons: 7 percent
  • Ophthalmologists: 6 percent 

4. The American College of Surgeons and the Surgical Care Coalition are among the groups that objected to the proposed fee schedule. ACS Executive Director David Hoyt, MD, said: "Today's proposed rule from [CMS] is a big disappointment for patients and surgeons. … All we ask is that Congress protect America's surgeons so we can continue to do our jobs." 

5. The Surgical Care Coalition is lobbying Congress to waive Medicare's budget neutrality requirements for these E/M adjustments and increase all 10- and 90-day global code values.  

6. In a recent survey conducted by the SCC, private surgical practitioners said the proposed rule would likely force surgeons to take fewer Medicare patients. 

7. The rule also solidified the COVID-19-related temporary changes made to increase access to telehealth. The proposed rule would make those temporary changes permanent. 

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