Take Action to Oppose the 9% Medicare Cut
E&M stands for "evaluation and management". E&M coding is used when a patient encounter includes notation of relevant history, physical examination findings, and prior diagnostic test results; assessment, clinical impression, or diagnosis; and medical decision making. Effective January 1, 2021, CMS is planning to increase payment for office/outpatient E&M visits for primary care and non-procedural specialty care for work associated with visits that are part of ongoing, comprehensive primary care and/or ongoing visits related to a patient's serious or complex chronic condition. This is happening in part because in 2017 it was determined that in about 60% of visits Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians; therefore, this adjustment is intended to make payment to primary care better reflect the time spent on evaluation and management since they are less likely to be performing specific procedures.
PPS has been lobbying on this issue since it arose in 2018. Following is a timeline of actions and letters.
- Helped achieve record-breaking 158 Members of Congress joining a Congressional sign-on letter in the form of public comment to CMS challenging the cuts to specialists to pay for E&M code increases (September 2020)
- PPS submitted public comment to CMS challenging the 9% cut (deadline October 5, 2020)
- 229 Members of Congress are now on record asking Speaker Pelosi and Minority Leader McCarthy to pass legislation before the end of the year in order to mitigate the 9% cut (October 2020)
- PPS and 35 other stakeholders call on Congress to prevent CMS from implementing drastic cuts to physical therapy
- PPS endorsed Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) in order to prevent the 9% cuts, permanently extend Medicare coverage of telehealth to PTs, and reduce administrative burdens.
- PPS and 52 other organizations request Congress waive budget neutrality requirements in order to prevent cuts to specialties (8% to PT) to pay for E/M code increases on January 1, 2021 (June 2020)
- PPS and APTA joint letter to HHS requesting regulatory changes to make telehealth for PT permanent, prevent the 8% cut, modify plan of care signature requirement, change PTA supervision from direct to general, and allow for PTAs to perform maintenance therapy (June 2020)
- 99 Representatives ask CMS for transparency about the methodology and considerations it used to determine which specialties to cut and by how much in order to pay for an increase in E/M codes (January 2020)
- Per PPS request, Senator Tester (Montana) sends letter to CMS on behalf of physical therapists, sharing concerns about the impact of 8% cut to reimbursement rates on rural communities (January 2020)
- PPS, APTA, and APTQI letter requesting MedPAC evaluate current inadequacies of Medicare's physical therapy reimbursement and future impact of an 8% cut (January 2020)
- Ask your Member of Congress to Include in upcoming legislation a waiver of the budget neutrality requirement that is forcing CMS to pay for an increase in Evaluation and Management (E/M) codes. If CMS proceeds to cut physical therapy reimbursement by 9% as planned, many community-based outpatient physical therapy clinics who are barely hanging on through the joint impact of the public health emergency and economic crisis will go out of business.
Send Comments to CMS
Send your comment letter to CMS today, and encourage your staff to do the same, through the APTA Regulatory Action Center.
Watch this video from PPS Government Affairs Committee Member Theresa Marko to see just how easy it is.
Engage your staff
Ask your staff to send their own letters con Congress! Send them through the APTA Action Center, or use the templates below to email or call their members of congress.
Engage your patients, friends, and family in advocacy!
Every voice counts! Ask your Medicare patients to call or email their Senators and Representatives. Consider engaging your office staff to help them take action while in your office.
Use the Patient Advocacy Center on the APTA website, or give them this template to send their own email or phone call.
Patient Advocacy Works! Watch this video from PPS member Anthony DiFilippo and see how easy and effective it can be!
Social Media Resources – download these images provided by APTA and post them to your social media account. Be sure to include a link to the Action Center.Download Package of All Ads