Dear Administrator Verma:
We are writing to express our strong opposition to a provision in the 2020 Medicare Physician Fee
Schedule proposed rule. Specifically, we are very concerned with the proposal to not include in the global
codes the adjusted values for the revised office/outpatient evaluation and management (E/M) codes. We
believe that CMS is arbitrarily implementing the E/M adjustments in a manner that runs counter to current
law. Should CMS finalize its proposal to adjust the office/outpatient E/M code values, the agency must
also apply these updated values to the global codes.
First, changing the values for some E/M services but not for others disrupts the relativity mandated by
Congress as part of the Omnibus Budget Reconciliation Act (OBRA) of 1989 (P.L. 101-239). Since the
fee schedule was established, E/M codes have been revalued three times. Each time the payments for
office/outpatient visits were increased, CMS also adjusted the bundled payments to account for the
increased values of the E/M portion of the global codes.
Additionally, the Medicare statute specifically prohibits CMS from paying physicians differently for the
same work, and the “Secretary may not vary the … number of relative value units for a physicians’
service based on whether the physician furnishing the service is a specialist or based on the type of
specialty of the physician.”1 Failing to adjust the global codes as proposed is equivalent to paying some
physicians less for providing the same E/M services.
Read full letter here
