Bipartisan bill aims to stop CMS from slashing imaging reimbursement

October 14, 2020
by Valerie Dimond, Contributing Reporter
Earlier this month, Rep. Michael Burgess, MD, R-Texas, and Rep. Bobby Rush, D-Ill., proposed new legislation (H.R. 8505) that would waive the budget neutrality requirement for evaluation and management (E/M) CPT code increases mandated by the Medicare Physician Fee Schedule.

Proposed by the Centers for Medicare and Medicaid Services (CMS) in mid-August, and scheduled for implementation next year, title XVIII of the Social Security Act would severely hurt radiologists who are already facing large cuts in imaging volumes and strained revenue streams during the COVID-19 pandemic.

“Application of budget neutrality and resulting cuts to pay for E/M increases will slash radiology payments by 11 percent — starting as early as January 1, 2021,” said the American College of Radiology (ACR) in a public statement. “The new policy hurts physicians who do not often bill E/M services. With COVID-19’s financial impact on practices, this CMS action will harm providers and patient access to care.”

The proposed rule contains more than 40 new or revised codes that affect radiology and, after factoring in proposed valuation adjustments, would affect different areas in the following ways:

• Diagnostic radiology – 11% decrease
• Interventional radiology – 9% decrease
• Nuclear medicine – 8% decrease
• Radiation oncology and therapy centers – 6% decrease

The new bill issued by Burgess and Rush would amend this rule with a one-year waiver on budget neutrality requirements. Rep. Pete Olson, R-Texas, and Rep. Gerald Connally, D-Va., are the latest representatives to cosponsor the legislation.

“Introduction of the bill represents a positive step in the ongoing effort to highlight the expected negative impact of the looming cuts and spur congressional intervention before the end of the year,” ACR said.

After the bill was introduced, CMS administrator Seema Verma received a joint letter a few days later from ACR and 46 other provider groups, including the Society of Interventional Radiology, urging CMS to rethink its plan, which they say would cripple the recovery of the nation’s healthcare system.

“It is counterintuitive to put forth drastic reductions to reimbursement at a time when both Congress and HHS are focused on engaging patients, increasing the delivery of integrated, team‐based care, expanding chronic disease management, and reducing hospital admission/readmission rates for beneficiaries residing in the community as well as those in long‐term nursing facilities,” wrote the coalition. “CMS must recognize how the reimbursement reductions for our providers fail to align with CMS’ efforts to drive better patient access to care and management.”

The bill has been introduced to multiple House committees for consideration.