CMS (Finally) Releases 2020 CY Physician Fee Schedule

PFS Proposed Rule Would Slightly Increase Laboratory Payments With No Negative Impact on Pathologist Payments

The CY 2020 Medicare Physician Fee Schedule (PFS) Proposed Rule has finally been released, delayed by three weeks to address issues raised in a Presidential Executive Order on healthcare price and quality transparency.

Overall, CMS projects that the changes to the PFS payment policy will increase aggregate CY 2020 PFS payments to independent laboratories by one percent while holding steady aggregate payments for pathologists. Given the sizable cuts in the clinical laboratory fee schedule (CLFS), pathologists as a whole are likely to be less adversely impacted in CY 2020, as independent laboratories receive approximate 83 percent of their Medicare revenues from the Clinical Laboratory Fee Schedule.

As always, each year brings a lot of variation in reimbursement amounts for individual pathology HCPCS codes. For the most part, this year’s proposed rule seemed to provide fewer significant cuts. On the upside, the following codes would experience significant increases (10 percent or more), though these changes mostly effected technical component payments: CPT code 88319-TC, enzyme histochemistry (+20 percent); 88346-TC, immunofluorescence, 1st stain, (+22 percent); 88350-TC, immunofluorescence, each additional stain (+31 percent); 88362-TC, nerve teasing preparation (+15 percent); 88381-TC, microdissection (+21 percent); 88388-TC, tissue examination, molecular study, add-on (+13 percent); and 96935 Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image (+37 percent). Several cytopathology codes (HCPCS codes 88141, G0141-TC, G0141-TC, P3001) were flagged by CMS as potentially misvalued and would be cut, per the Agency’s proposal, 19 percent. Perennial CMS target G0416 is being targeted for a 19-percent cut, this time to the technical component. For details on how CMS’s proposals would affect individual HCPCS Codes, click here.

Evaluation/Management Codes

That said, one issue to keep an eye on concerns the Agency’s plans to revise its evaluation and management (E/M) codes, which will not be implemented until CY 2021. CMS has proposed adopting a proposal from the American Medical Association’s (AMA) E/M workgroup. Because of the revenue neutral requirements placed on the Medicare PFS, CMS’s plans to increase payment for these services must be offset by cuts to other services. CMS is projecting that adopting the AMA E/M proposal could cut reimbursement for pathologists and independent laboratories by eight and four percent, respectively, in CY 2021.

QUALITY PAYMENT PROGRAM

According to CMS, 98 percent of eligible clinicians successfully participated in MIPS in 2018, up from 95 percent in 2017. CMS also reported that “four of the five quality measures within the pathology specialty set have been identified as extremely topped out.” To support pathologist participation in the MIPS program, the Agency stated that it plans to keep the four MIPS pathology measures, e.g., Barrett's Esophagus, Radical Prostatectomy Pathology Reporting, Lung Cancer Reporting (Biopsy/Cytology Specimens), and Lung Cancer Reporting (Resection Specimens), at least through 2020. The Agency did indicate, however, that it received comments indicating that physicians are reporting on measures on which they believe they will score well. As a result, CMS is considering increasing its data completeness threshold for quality measures that are identified as extremely topped out, but are retained in the program due to the limited availability of quality measures for a specific specialty.

Considering its concerns about the lack of reported measures for some specialties, CMS urged stakeholders to continue to develop new measures to create new opportunities for quality improvement. In addition, CMS stated that it “encourages pathologists to consider reporting on pathology specific QCDR measures through a CMS-approved QCDR,” such as ASCP's National Pathology Quality Registry, for the 2020 performance period.

In addition, to address concerns that the QPP reporting requirement is too costly and burdensome, CMS has proposed (for CY 2021 implementation) streamlining MIPS using an episode-based approach, called MIPS Value Pathways (MVP). The proposal is similar to one outlined by the American Medical Association.

ASCP is currently reviewing the proposed rule in detail and will be submitting formal comments on it before the September 27 comment deadline.

Other articles in the August 2019 ePolicy News:

ASCP Urges Anthem to Reconsider Cuts to Pathology, Laboratory Rates
ACLA Scores Major Legal Win in PAMA Lawsuit
Cervical Cancer Risk Guidelines Public Comment Now Open
NASEM Committee to Identify Gaps in Clinical Practice Guidelines for Acute Pain Opioid Prescriptions

To read more articles from ePolicy News click here.

For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

ASCP ePolicy News is supported by an unrestricted grant from Hologic.