SCAI recently objected to the Centers for Medicare & Medicaid Services (CMS) proposal to reduce Medicare’s conversion factor by 10.6% in 2021. This is a key component of payment rates for all procedures. CMS is doing this in an effort to offset significant payment increases for evaluation and management (E&M) services. The net effect of these changes is estimated to be -3% for interventional cardiologists. Under normal circumstances, CMS is required to make changes to the fee schedule revenue neutral but these are not normal times. SCAI recommends that CMS use emergency powers and/or new legislation to not reduce the conversion factor in 2021. SCAI is working to obtain legislation enacted to force CMS to change its plans.

Other recommendations that SCAI made were:

  • Remove the National Coverage Determination (NCD) for Transvenous (Catheter) Pulmonary Embolectomy (240.6) which bans coverage of these procedures. The NCD is outdated and is causing confusion among physicians, hospitals, and patients. This NCD is nearly 40 years old and has never been reconsidered. The NCD does not provide any details about the procedure or devices and fails to cite any evidence supporting non-coverage.
  • For CMS to accept all the RUC’s work value recommendations for new and revised CPT codes for 2021. We objected to CMS’s plans to lower the work values for one of the three new atrial septostomy codes. CMS proposes to use the RUC survey’s 25th percentile work RVU of 8.00 instead of the 10.50 median work RVU recommended by the RUC. We maintain that CMS did not recognize the significantly increased intensity and complexity of placing a stent within the beating heart with the risk of the stent embolizing from the intended location.
  • CMS had asked for stakeholder input regarding payments for Prothrombin/International Normalized Ratio (PT/INR) services. SCAI is not equipped to comment on some of the cost details, but registered concerned about adequate patient access because of the payment declines of nearly 75 percent for these procedures may reduce patient access and result in unfortunate health outcomes.