Dear Administrator Verma:
We are writing to express our strong opposition to a provision in the 2020 Medicare Physician
Fee Schedule proposed rule regarding the values of E/M office visits in global fee payments.
Specifically, CMS proposes to increase the value of standalone E/M office visits beginning in 2021. However, the agency did not propose to increase the value of post-operative E/M visits
that are bundled into 10- and 90-day global surgery codes. Arbitrarily adjusting some E/Ms but
not others disrupts the relativity of the fee schedule and is in conflict with current law.
Increasing 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
