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2017 Final Rule – Medicare Physician Fee Schedule CMS Listens to Texas Orthopaedic Surgeons

November 3, 2016

CMS released the final rule for the calendar year 2017 Medicare Physician Fee Schedule on November 2, 2016, and CMS dedicated a large amount of the commentary to how it will collect data on global surgical packages. Thanks to the Texas orthopaedic surgeons who responded to the AAOS/TOA survey on August 12. As a result of your work, Texas orthopaedic surgeons will not have to report additional data on every 10-minute increment of your service.

AAOS’s lobbying team played a tremendous role to influence this final decision. AAOS’s lobbyists engaged dozens of Members of Congress to encourage CMS to scale back its efforts.

To review, CMS eliminated 10- and 90-day global surgical packages in the 2014 Medicare Physician Fee Schedule and turned them into 0-day global services that would result in additional post-operative services being paid separately. However, Congress restored the global surgical packages in the Medicare physician payment overhaul – MACRA – in the spring of 2015. Congress directed CMS to collect data on global surgical packages and determine whether they should continue in the future.

In CMS’s CY 2017 proposal, which was released in July 2016, CMS proposed to add a G code that would have required surgeons to report a whole new set of codes to document the type, level and number of pre- and post-operative visits furnished during the global period for every global surgery procedure provided to Medicare beneficiaries. Under this system, surgeons would have been required to use a new set of G-codes to report on each 10-minute increment of services provided beginning on January 1, 2017.

CMS scaled back the reporting for surgeons in its CY 2017 final rule released on November 2, 2016. It appears that Texas orthopaedic surgeons will not be affected. Thank you to all of the TOA members who responded to the AAOS survey. CMS noted the survey results in its commentary and referred to the fact that many orthopaedic surgeons indicated that collecting the G-codes would have been a tremendous burden.

Per CMS, the final provisions include (for certain states other than Texas):

  • “CPT code 99024 will be used for reporting post-operative services rather than the proposed set of G-codes. Reporting will not be required for pre-operative visits included in the global package or for services not related to patient visit.”
  • “Reporting will be required only for services related to codes reported annually by more than 100 practitioners and that are reported more than 10,000 times or have allowed charges in excess of $10 million annually.”
  • “Practitioners are encouraged to begin reporting post-operative visits for procedures on or after January 1, 2017, but the mandatory requirement to report will be effective for services related to global procedures furnished on or after July 1, 2017.”
  • “Only practitioners who practice in groups with 10 or more practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island will be required to report. Practitioners who only practice in smaller practices or in other geographic areas are encouraged to report data, if feasible.”

Click here to review the survey results that were shared with CMS. Orthopaedic surgeons made up the largest percentage (25 percent) of the surgeon responses to the survey. And surgeons from the southern region, which includes Texas, made up the greatest percentage of surgeon responses (36 percent). Again, thank you to all of the orthopaedic surgeons who read TOA’s e-mails and respond to our action items.

Click here to access this link on our protected page to gain access to to view all of the other issues in the CY 2017 Medicare Physician Fee Schedule that TOA highlighted when the proposed rule was released in July 2016 as well as TOA’s July 2016 analysis of the proposed rule included several other areas of interest to orthopaedic surgeons.