CMS Releases Final 2021 Medicare Physician Fee Schedule Rule
On Dec. 1, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule. Under the proposal, neurosurgeons face overall Medicare payment cuts of approximately 6% beginning on Jan. 1, 2021. The reductions are primarily driven by new values for office and outpatient evaluation and management and other visit codes. The new payment policies will result in a significant budget-neutrality adjustment to the Medicare conversion, which will be reduced from $36.09 in 2020 to $32.4085 in 2021 — a 10.2% reduction. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) continue to advocate for Congress to override these cuts.
Legislation to Prevent Medicare Payment Cuts Introduced
On Oct. 30, eight bipartisan members of Congress — Reps. Ami Bera, MD, (D-Calif.); Larry Bucshon, MD, (R-Ind.); Brendan Boyle (D-Pa.); George Holding (R-N.C.); Raul Ruiz, MD, (D-Calif.); Phil Roe, MD, (R-Tenn.); Abby Finkenauer (D-Iowa); and Roger Marshall, MD, (R-Kan.) — introduced H.R. 8702, the “Holding Providers Harmless From Medicare Cuts During COVID-19 Act.” The purpose of the legislation is to hold health care providers harmless from Medicare payment cuts in 2021 and 2022, while the nation continues to contend with the effects of the COVID-19 pandemic. Under the legislation:
- Providers billing for eligible services under Medicare Part B — including certain E/M services — would receive an additional per service relief payment in 2021 and 2022 if the payment for the service would be lower than the 2020 payment rate;
- The additional relief payment will equal the difference between the Medicare Physician Fee Schedule (MPFS) amount in 2021 and 2022 and the amount the service was paid in 2020;
- Services with 2021 and 2022 payment rates higher than in 2020 are not eligible for the additional relief payment; and
- E/M services with higher 2021 and 2022 payment rates than in 2020, including E/M codes paired with the new GPC1X add-on code, would not be eligible for the additional relief payment.
Neurosurgery praised the legislation individually and through our efforts with the Surgical Care Coalition and Reps. Bera and Bucshon, taking the following actions:
- AANS/CNS letterto Reps. Bera and Bucshon endorsing the bill;
- AANS/CNS press releaseannouncing neurosurgery’s endorsement of the bill;
- Coalition lettersupporting the bill;
- Surgical Care Coalition press releaseannouncing the legislation;
- Surgical Care Coalition announces its supportfor the bill; and
- Bera and Bucshon press releaseunveiling the bill.
As a precursor to the introduction of H.R. 8702, Reps. Bera, Bucshon and others led a Congressional sign-on letter to House leaders urging Congress to act before the end of the year to prevent the cuts. This bipartisan letter was signed by 229 members of Congress. The AANS and the CNS issued a press release thanking them for their efforts.
In the release, Ann R. Stroink, MD, FAANS, chair of the AANS/CNS Washington Committee, stated, “America’s neurosurgeons appreciate the leadership of Reps. Bera, Bucshon and others for their efforts on multiple fronts to prevent these harmful cuts.” She added that such “an overwhelming showing on this letter to House leaders clearly demonstrates significant bipartisan support for Congress to act this year to protect Medicare beneficiaries’ timely access to care.”
Neurosurgery Asks Congress to Suspend Medicare Payment Sequester
On Nov. 9, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) joined the Alliance of Specialty Medicine in a multi-specialty letter urging Congress to extend the Medicare sequestration relief provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136). Section 3709 provided a temporary suspension of the annual 2% Medicare payment sequester from May 1, 2020, through the end of 2020. This provision of the CARES Act has provided critical relief when the provider community is suffering severe financial losses due to the drastic decreases in non-COVID-19-related and non-emergency care.
Following this action, on Nov. 11, the AANS and the CNS also signed a coalition letter asking Congress to extend the current moratorium on the Medicare sequestration cuts until the end of the public health emergency. The letter notes that the pandemic will continue to place financial stress on our nation’s health care system, threatening the viability of those serving the most vulnerable communities. Therefore, Congress should act before the end of the year “to prevent the additional, damaging financial stress that would be caused by the return of the Medicare sequester.”
Neurosurgery Objects to Burdensome Prior Authorization Requirements
On Nov. 2, the AANS and the CNS sent a letter to Independence Blue Cross of Philadelphia regarding coverage guidelines requiring a physiatry consultation to authorize lumbar spinal fusion procedures, including fractures and tumors. The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves (DSPN) prepared the response, objecting to the care delays that will ensue if patients must first see a physiatrist as a condition of prior authorization for medically necessary spine surgery. The organizations have requested a follow-up meeting with the plan’s medical director.
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