On July 29, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2020 Medicare Physician Fee Schedule (MPFS) and other changes to Medicare Part B payment policies, including proposals related to the Quality Payment Program (QPP). At the same time, CMS released the Hospital Outpatient Prospective Payment System (HOPPS) proposed rule for 2020.
In the MPFS proposal, CMS estimates a 0% overall impact for both the hematology/oncology and radiation oncology specialties in 2020. Targeted cuts to oncology were limited to two drug administration codes—96360 and 96372—which were identified as misvalued in the 2018 final rule. It is important to note, however, that the actual impact on individual physician practices will depend on the mix of services the practice provides.
CMS is also proposing to align Evaluation & Management (E&M) coding with changes laid out by the Current Procedural Terminology (CPT) Editorial Panel for office/outpatient E&M visits. The proposed CPT coding changes retain five levels of coding for established patients, reduce the number of levels to four for E&M visits for new patients, and revise code definitions.
Under QPP, CMS is proposing changes to the weighting of performance categories and the overall score needed to avoid a negative payment adjustment in the Merit-Based Incentive Payment System (MIPS).
The 2020 HOPPS proposal would increase hospital outpatient reimbursement rates by 2.7%. The proposed rule would also continue cuts to the 340B drug pricing program, which began in 2019 and lowered reimbursement for certain separately payable 340B drugs and biologics from Average Sales Price (ASP) plus 6% to ASP minus 22.5%.
ASCO continues to analyze the proposed rules and will provide feedback to CMS during the open comment period, which closes on September 27.
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