Rheumatology Leaders Applaud Updates to Evaluation and Management Codes in CMS 2020 Physician Fee Schedule Proposed Rule

WASHINGTON, D.C. – The American College of Rheumatology (ACR) today applauded the Centers for Medicare & Medicaid Services (CMS) for including proposed reimbursement changes to evaluation and management (E/M) codes in its CY 2020 Physician Fee Schedule Proposed Rule. If finalized, the proposal would increase Medicare reimbursement for time-intensive healthcare services provided by cognitive specialists such as rheumatologists. These services include examinations, disease diagnosis, risk assessments, and care coordination.

“The ACR applauds CMS for recommending long-needed updates to E/M codes in its CY 2020 Physician Fee Schedule proposed rule,” said Paula Marchetta, MD, MBA, president of the ACR. “Rheumatologists and other cognitive specialists should be adequately reimbursed for the time-intensive, high-value services they provide to Medicare beneficiaries. The proposed changes would more closely align reimbursement for E/M services with the time and expertise they require, and will help ensure millions of Medicare beneficiaries continue to receive these vital healthcare services. We hope to continue to work with CMS to ensure the expertise provided by rheumatologists and other cognitive specialists is appropriately reimbursed.”

Healthcare services billed under E/M codes – which include examinations, disease diagnosis, risk assessments, and care coordination – are grossly under-compensated by Medicare, according to a 2018 report from the Medicare Payment and Advisory Commission (MedPAC).

The CMS proposal aligns with recommendations set forth by the American Medical Association in collaboration with a diverse group of professional societies representing cognitive specialties, including the ACR. The ACR also engaged with the administration through meetings, phone calls, and public comments to provide the perspective of rheumatologists.

“We thank CMS for giving rheumatology leaders ample opportunities to interact with the agency on this issue and look forward to providing further feedback in written comments,” said Dr. Marchetta.

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 About the ACR

The American College of Rheumatology (ACR) is the nation’s leading medical association representing the rheumatology care community, representing more than 7,700 U.S. rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.