GI societies praise CMS for expanding CRC screening, raise concerns for reimbursement cuts
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While applauding CMS’ 2023 Medicare Physician Fee Schedule for expanding Medicare coverage of colorectal cancer screening, gastrointestinal societies also voiced concerns over the reimbursement cuts to gastroenterology services.
“In a win for patients and thanks to our collective advocacy efforts, CMS will expand Medicare coverage of colorectal cancer screening tests by reducing the minimum age payment limitation from age 50 to age 45, beginning in 2023,” ACG, AGA and ASGE noted in a joint statement. “CMS will also expand the regulatory definition of ‘CRC screening tests,’ beginning in 2023, to include the colonoscopy after a positive stool-based CRC screening test.”
Aligned with recently revised recommendations from the U.S. Preventive Services Task Force and the U.S. Multi-Society Task Force on Colorectal Cancer, this CMS update is expected to waive beneficiary cost-sharing for necessary follow-up colonoscopy following a non-invasive colorectal cancer screening test.
According to the joint statement, “this policy change would directly advance health equity by promoting access and removing barriers for much needed cancer prevention and early detection within rural communities and communities of color that are especially impacted by the incidence of CRC.”
However, the GI societies noted that the 2023 CMS final rule, effective as of January 1, 2023, also includes “an approximately 4.5% reduction” — from $34.61 to $33.08 — from the 2022 physician conversion factor.
The ACG, AGA and ASGE also drew attention to the CMS’ decision to delay implementation of the “split/shared visit” policy until 2024. The split/shared visit policy stems from a 2022 Physician Fee Schedule final rule allowing payments in which physician and non-physician providers deliver services together for a split/shared facility-based visit, including prolonged visits. Implementing this policy would require a provider to deliver more than half of the care during such shared/spilt visits to bill for the services.
“Gastroenterologists furnishing split/shared E/M visits will continue to have a choice of history, physical exam, medical decision-making or more than half of the total practitioner time spent to define the substantive portion, instead of using total time to determine the substantive portion, until [calendar year] 2024,” ACG, AGA and ASGE said in the statement. “The GI societies and many other specialties pushed CMS not to implement its new definition of ‘substantive portion’ as more than half of the total visit time and we will continue to advocate against implementation of this policy change.”
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Medicare 2023 Final Payment Policies Released. https://files.constantcontact.com/11178001701/c7a31dae-14b9-4086-a0be-cff68ed4137a.pdf?rdr=true. Accessed Nov. 22, 2022.
Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule. Accessed Nov. 22, 2022.
Huge win for patients: CRC screening coverage continuum is complete. https://gastro.org/news/huge-win-for-patients-crc-screening-coverage-continuum-is-complete/. Accessed Nov. 22, 2022.
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