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    SCAI Advocates on Behalf of Interventional Cardiologists Regarding CMS Proposed 2017 Physician Fee Schedule

    September 08, 2016

    Supporting appropriate coding and reimbursement, the Society for Cardiovascular Angiography and Interventions (SCAI) recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding the 2017 Medicare Physician Fee Schedule Proposed Rule. This schedule updates payment policies, payment rates, and other provisions for services under the Medicare Physician Fee Schedule on or after January 1, 2017. CMS estimates that the net effect of these changes will be a 1% fee increase for cardiologists in 2017.

    As the only society solely focused on advancing interventional cardiology care for our patients, SCAI advocated for:

    • Removal of the segment elevation myocardial infarction current procedural terminology (STEMI CPT) code from CMS’ list of codes targeted as potentially misvalued

    • Addition of specific codes to the list of invasive cardiology codes for which the surgical malpractice factor is applied in the calculation of professional liability insurance relative value units:

      • The new paravalvular leak (PVL) repair codes
      • The transesophageal echocardiography guidance code used to report guidance of structural heart disease procedures
    • NO carve out of the work value of moderate sedation from those codes for which claims data supports this work is inherent (including diagnostic cardiac cath codes and percutaneous coronary intervention codes) 

    • Use of existing evaluation and management CPT codes to gather data regarding follow-up care provided within the global period for 10- and 90- day global period codes

    • Advocated that CMS accept, not lower, the RUC recommended payments for the new PVL repair left atrial appendage occlusion (LAAO) codes

    The Alliance of Specialty Medicine – of which SCAI is a memberalso submitted comments to the CMS, requesting changes to CMS’ proposed values of the new PVL and LAAO codes. CMS will review all submitted comments before publishing the Final Rule in November. You can read SCAI’s full comment letter here.