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August 5, 2020

SCAI Seeks to Challenge Reductions in Proposed CMS Payment Schedule

August 5, 2020—The Society for Cardiovascular Angiography & Interventions (SCAI) announced that the Centers for Medicare & Medicaid Services (CMS) is proposing a shift in payments from procedures and to evaluation and management services for 2021.

According to SCAI, if implemented, fees for most procedures will drop approximately 9%, and payments for evaluation and management services will increase by up to 14%. Average fees for cardiac surgeons will decrease by 10%. For family practices, average fees will increase by 13%.

The SCAI announcement includes a chart showing how the top 10 services provided by interventional cardiologists may be affected if the proposal is implemented. The society advised it is working with a coalition to have Congress override the reductions for procedures.

Additionally, SCAI advised that CMS responded to the American Medical Association Relative Value Committee’s (RUC’s) recommendations on the work values for new/revised and reviewed codes. CMS accepted 75% of the RUC’s recommendations and reduced the values for most of the rejected recommendations.

A PDF of the complete 1,355-page document, “Medicare Program; CY 2021 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; et al” (CMS-1734-P), is available online. The CMS Fact Sheet of the proposed policy, payment, and quality provisions changes is also available on the agency’s website.

As noted by SCAI, CMS proposals regarding interventional cardiology include accepting the recommendations for atrial septostomy (p. 245) and percutaneous ventricular assist device insertion (p. 247). CMS is proposing to lower the recommendations for intracardiac echocardiography (p. 280) and ventricular assist device interrogation (CPT code 93750; p. 281). For transcatheter intracardiac shunts (p. 246, 313) CMS accepted one value and is proposing to reduce another.

Additionally, CMS is proposing to remove 11 National Coverage Decisions (NCDs) that appear to be outdated/unnecessary (p. 526). SCAI advised that this list does not include the “antiquated” 40-year pulmonary embolism coverage policy. SCAI will reiterate its objection that NCD 240.6 needs to be removed to ensure that facilities will make newer pulmonary embolism procedures available to physicians and their patients, stated the society announcement.

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