AACU News & Notes

CMS Finalizes 2020 Medicare Payment Rules

posted: November 6, 2019

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective the beginning of 2020.

In September, the AACU submitted a comment letter to CMS supporting various coding changes (e.g. for E/M office visits and patients with complex conditions), while opposing other changes, such as reduced valuations of certain urology-specific CPT codes and more stringent requirements for participation in the MIPS program.

The final rule implements several positive changes to the PFS:

  • CMS will not consolidate E/M codes and will implement revised code definitions that will result in a combined 8% increase in allowable E/M office visits payments for urology ($1,739), effective January 2021.
  • CMS will implement the RUC-recommended work RVUs for CPT codes used for Orchiopexy (7.73), Urography (0.51), and Biofeedback Training (0.90 and 0.50).
  • Notably, CMS raised the recommended price for the percutaneous neuro test kit (sacral nerve stimulators) from $114.52 to $413.24 in the final rule.

Unfortunately, the final rule included some provisions we opposed, including certain measures that were proposed in the President’s recent Executive Order.

  • The CPT codes for Cystourethroscopy Insertion Transprostatic Implant (UroLift®) were left at 4.00 and 1.01 despite RUC-recommended values of 4.50 and 1.20 respectively.
  • The MIPS performance threshold will increase from 30 points in 2019 to 45 points in 2020 and to 60 points in 2021. The threshold for the exceptional performance bonus will rise from 75 points to 85 points by 2020.
  • CMS will implement new regulations to allow physician assistants to perform certain services without general physician supervision as long as it meets state scope of practice rules for PAs.

The AACU is continuing to review the final rule and will work with our partners in the urology community and other specialty societies to further analyze its impact on physicians.

In the News

CMS Releases Physician Fee Schedule, OPPS, Pushes Site-Neutral Pay (RevCycle Intelligence, Nov 1)
“The rules will notably retain all five levels of evaluation and management (E/M) services, implement the second phase of site-neutral payments, and modify Quality Payment Program reporting. The federal agency intends for the two final rules to advance the Trump Administration’s efforts to modernize Medicare billing and put patients over paperwork.”

FierceHealthcare (Nov 1); PolicyMed (Nov 4); mHealth Intelligence (Nov 5)

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