American College of Gastroenterology Breaking News

CMS Releases Medicare Physician Fee Schedule Final Rule for CY2017

Today, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Medicare Physician Fee Schedule final rule. ACG, AGA and ASGE are currently reviewing the details of the final rule and will provide a more extensive summary soon.
This communication offers a topline summary of CMS’ finalized policy for moderate sedation in endoscopy, which has the greatest potential to affect GI clinicians. For calendar year (CY) 2017, CMS finalized its proposal to separate moderate sedation services from hundreds of procedure codes, including the majority of GI endoscopy procedures under Medicare Part B.
What this means for you:

  • There will be no financial impact for gastroenterologists who perform their own moderate sedation. Gastroenterologists performing their own moderate sedation for endoscopic procedures will now report two codes instead of one —  the procedure code and the proposed moderate sedation code — beginning January 1, 2017.
  • Gastroenterologists who use anesthesia professionals will see the value of the majority of all GI endoscopy procedures reduced by 0.10 RVUs. The reduction is less onerous than the 0.22 RVUs recommended by the AMA Relative Value Update Committee (RUC) and the 0.25 RVUs finalized by CMS for all other specialties’ procedures for which the value of moderate sedation is currently inherent to the procedure.

In making this change, CMS acted in accordance with member survey data provided by the GI societies. Based on these survey responses, ACG, AGA and ASGE provided information to CMS in-person and via written comments that moderate sedation, when provided by the endoscopist for GI endoscopy, is different work than for other procedures, such as pain management. In response, CMS has created a separate Healthcare Common Procedure Coding System (HCPCS) G code (G0500) for moderate sedation for GI endoscopy procedures.

Background on Moderate Sedation Services Under Medicare
CMS announced in 2014 that the agency wanted to separate moderate sedation services from procedure codes in all specialties, including gastrointestinal endoscopy procedures, in which the underlying service was originally valued with moderate sedation. Until now, the Agency has never placed a value on this moderate sedation work. For several years, the three GI societies have been working on behalf of gastroenterologists to educate CMS on this issue.

Proposed Values for Moderate Sedation 2017
The proposed value for moderate sedation for GI endoscopic procedures for 2017 is 0.10 work RVUs. Additional time may be reported with CPT code +99153, for each additional 15 minutes of intra-service time as appropriate. However, code +99153 will only have practice expense; no physician work.

RVU Changes for 2017 
Here are the 2017 Medicare physician work RVUs for the most commonly performed GI services:
Moderate Sedation Administered by the Same Provider
Sedation Administered by an Anesthesia Professional (e.g., MAC, general anesthesia)

GI Anesthesia Services Under Review
For 2017, CMS maintained the base value for the codes for anesthesia provided for upper (00740) and lower (00810) GI endoscopy on an interim basis. CMS continues to believe that the services are potentially misvalued and will continue to seek outside input as the codes are moving through the CPT and RUC processes.

Next Steps
ACG, AGA and ASGE are currently reviewing the details of the final rule and will provide a more extensive summary of the entire rule soon. 

The final rule will be published in the Federal Register on November 15, 2016. Our societies will be analyzing the rule and providing comments to CMS.
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