American Society of Plastic Surgeons
For Consumers

Action Alert: Tell Congress to Stop Cuts to Surgeon Reimbursement

On August 3, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that represents a significant threat to physician practices by cutting 2021 Medicare E/M payments for many specialties, including by approximately 7 percent for plastic surgery. Contact your Congressional Representative today and urge him or her to support critical legislation preventing payment cuts in the proposed 2021 Medicare Physician Fee Schedule.

What's in (and not in) the rule?

Under the proposed rule, physicians would see a reduction to the conversion factor of more than 10 percent - from $36.09 in 2020 to $32.26, effective January 1, 2021. This reduction mostly stems from required adjustments to achieve a budget-neutral payment system, under which new spending from changes to evaluation and management (E/M) payments must be offset by cuts elsewhere.

For nearly four years, CMS has been analyzing the number of post-operative visits that are appropriate for any surgical procedure. The agency maintains that the number of visits are overinflated, but has only provided preliminary reports from the RAND (a practitioner survey on level of post-op visits, claims-based reporting of post-op visits) and has yet to provide final reports and recommendations, which ASPS has requested be available before 2021.

In the proposed rule, CMS has failed to incorporate the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC)-recommended work and time incremental increases for the revised office/outpatient visit E/M codes in the global codes. Specifically, the agency has disregarded the valuation for six of 14 plastic surgery codes that underwent a review in 2019, instead opting to compare these codes to others with similar total time. In four of the six instances, CMS focused on CPT codes that had not undergone a RUC review in more than 14 years, despite ASPS supplying in each instance a list of five or more codes that had been revalued in the last 10 years as comparators.

Of the six codes in question, the three with the largest decreases are outlined below. It is worth noting that these proposed changes may significantly inhibit access to breast reconstruction in the Medicare population.

  1. Tissue Expander Placement: 2020 value = $18.50/2021 proposed value = $14.84 (3.66 drop in existing wRVU)
  2. Immediate Implant: 2020 value = $13.99/2021 proposed value = $10.48 (3.51 drop in wRVU)
  3. Delayed implant: 2020 value = $12.63/2021 proposed value = $10.48 (1.82 drop in wRVU)

Ongoing advocacy

ASPS has been active on this issue since it first emerged, but the Society has ramped up its efforts over the past couple of months, serving as one of the founders of the Surgical Care Coalition, which focuses specifically on E/M changes and other reimbursement issues, and now on the impacts of the proposed changes to the conversion factor as well. ASPS has also been working in close coordination with other specialty societies, the American Medical Association, and the American College of Surgeons. Organized medicine has been joining to ask policymakers in both Congress and the administration to intervene to prevent these cuts.

ASPS has efforts planned to continue to advocate for key changes to the agency's proposed rule. But in order to prevent devastating payment cuts, Congress needs to put pressure on CMS to make positive payment updates. Be sure to take action and contact your member of Congress today to request support for this critical legislation.