2016 Colonoscopy Rates Soon to be Cut?

The Centers for Medicare and Medicaid Services (CMS) recently released the 2016 Medicare Fee Schedule (MPFS), which called for significant reductions in reimbursement rates for colonoscopies and other lower gastrointestinal (GI) procedures.

Experts understand the gravity of this potential cut — up to 19% – as it could possibly hinder public health efforts to mitigate incidences of colorectal cancer.

Actively working to counter these cuts, representatives from the American Society for Gastrointestinal Endoscopy (ASGE), the American College of Gastroenterology (ACG), and the American Gastrointestinal Association (AGA) are slated to meet with CMS leadership in late July.

The GI and surgical societies had presented their proposal and recommendations (from survey data) regarding physician work and practice expenses related to colonoscopy to the American Medical Association’s (AMA) Relative Value Update Committee (RUC) back in February 2014.

Although the lower reimbursement rates for colonoscopies and other procedures are considered “proposed,” this summary highlighted the changes in rates for the top lower GI endoscopy procedures.

During the MPFS Final Rule in 2012, CMS had identified colonoscopy, EGD, and other GI endoscopy procedures as potentially misvalued through the Misvalued Code Initiative. As such, over the last three years, representatives from the ACG, AGA, and ASGE, had all enacted public relations, regulatory, and legislative strategies and have successfully delayed the revaluation of colonoscopy and other lower GI procedures.

The next steps will involve thorough reviews of the proposed rules of MPFS and Hospital Outpatient Prospective System/ Ambulatory Surgical Center Payment Systems. All comments are due September 8, 2015. Rates will reportedly be finalized in November, and the final action will take effect January 1, 2016.