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November 5, 2018

Significant policy and payment changes in 2019 Medicare Physician Fee Schedule

GI codes to be revalued after CMS sides with Anthem; E/M payment changes delayed.

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On Thursday, Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule, which includes several significant policy and payment changes that are expected to impact gastroenterologists beginning in CY 2021.


Most significantly, CMS will revalue colonoscopy with snare (45385) and EGD with biopsy (43239), which may impact these code families. In an unprecedented and disturbing development, both services were nominated as potentially misvalued by Anthem, a major player in the U.S. health insurance market. This is the first time a private payor has nominated CPT codes via the potentially misvalued codes process.


The agency also finalized many of the proposed Evaluation and Management (E/M) coding, documentation and payment changes, but delayed their implementation until Jan. 1, 2021. Stay tuned for a call to action on these issues.

ACG, AGA and ASGE are reviewing the final rule and will provide a detailed analysis. Read a topline summary of the GI codes revaluation and E/M components of the rule.


Review the fact sheets for the CY 2019 Physician Fee Schedule and the Quality Payment Program final rule.


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