GI societies slam CMS decision to side with Anthem, devalue GI codes — 5 insights

Major gastroenterology societies harshly criticized the 2019 Medicare Physician Fee Schedule final rule, which makes several significant policy and payment changes.

Here's what you should know:

1. The American College of Gastroenterology, American Gastroenterological Association and American Society for Gastrointestinal Endoscopy released a joint statement expressing dismay over the final rule.

2. CMS is revaluing reimbursement for colonoscopy with snare (45385) and EGD with biopsy (43239).

3. CMS is revaluing the codes in response to a letter from Anthem. The societies called the action a "disturbing development" and later stated, "This is the first time a private payer has nominated CPT codes via the potentially misvalued codes process."

4. The three societies are reviewing the final rule and preparing a detailed analysis they will release later.

5. The final rule is expected to impact gastroenterologists beginning in 2021.

ACG said in a statement, "It is a conflict for CMS to listen to a payer whose goal is to increase revenue and reduce costs by reducing payment for lifesaving GI procedures. It is both alarming and unclear why CMS set this precedent for GI codes."

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