On July 14, the Centers for Medicare & Medicaid Services (CMS) released the CY 2027 Medicare Physician Fee Schedule (MPFS) proposed rule. Below are some specific areas of interest for endocrinologists, which we will comment on:
- Overall reimbursement — While the proposal is expected to result in a 2.5% decrease in reimbursement for all physicians, CMS estimates that policies in the rule would result in a 2.5% increase for the endocrinology specialty. Positive changes in overall Medicare payment for endocrinology services are due to changes in the use of G2211 and other proposals that favor non-procedural practitioners over procedural practitioners.
- G2211 — The agency has proposed transitioning the G2211 complex care code into a MOD1 modifier code. This new modifier code will have the same descriptor as G2211 and can be reported and billed in the same way as the G-code. The modifier, when appended to an appropriate E/M code, will be reimbursed at 16% of the value of the billed E/M code.
- Fine Needle Aspiration — The rule also proposed to increase the reimbursement rate of Fine Needle Aspiration (FNA). The Society advocated for increasing the FNA reimbursement rate and we are pleased the agency is proposing this change.
- Remote Physiologic Monitoring — CMS has proposed that practitioners who provide remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services must first conduct a separately reportable initiating visit (either in-person or via telehealth) prior to starting RPM and RTM.
CMS has posted a fact sheet on the rule on their website. We will provide Endocrine Society members with an in-depth analysis of the rule on our website in August. Every year, CMS requests our feedback on their proposed changes, and we respond by submitting a comment letter to the agency. Comments are due on September 14.
In addition to the Physician Fee Schedule Rule, the Society will continue to work with the bipartisan chairs of the GOP and Democratic Doctors Caucus who introduced the Patients First Act on July 15, which would make reforms to Medicare Physician Payment. This legislation would provide an annual inflationary update to the Medicare Physician Fee Schedule tied to the Medicare Economic Index (MEI). The legislation would provide an increase of MEI minus 1%. The Society has urged the sponsors of the bill to ensure that endocrinologists and other non-procedural specialists who bill E/M services are supported in this proposal.
We will continue to advocate for legislation ensuring that endocrinologists and other specialties are adequately reimbursed for the care they provide.
