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SVS Victory in DC - Grassroots Effort Leads to CMS Reimbursement Change

CMS Change a Big Victory for Vascular Surgeons, Patients SVS Led Grassroots Effort on Ultrasound Procedures Following a grassroots effort by SVS and in a move that will protect reimbursements for vascular surgeons, the Centers for Medicare and Medicaid Services (CMS) has issued a correction notice to its 2018 Hospital Outpatient Prospective Payment System (HOPPS) Final Rule.

The correction notice reassigns CPT 93880 (Duplex scan of extracranial arteries; complete bilateral study) to Ambulatory Payment Classification (APC) 5523 (x-ray and related services, level 3) from APC 5522 (x-ray and related services, level 2), with a payment rate of $232.31 for level 3 versus $118.74 for level 2. This reassignment was effective on Jan. 1. Two other complete vascular ultrasound procedures, CPT 93930 (Duplex scan of upper extremity arteries or arterial bypass grafts) and CPT 93978 (Duplex scan of aorta, inferior vena cava, iliac vasculature or bypass grafts) were also reassigned to level 3. This action by CMS is a big victory for both vascular surgeons, who will receive fair reimbursement for imaging services and their patients, who will have access to non-invasive ultrasound procedures.

Due to the Deficit Reduction Act of 2005, which became effective in 2007, HOPPS payment rates also serve as a limit for vascular ultrasound procedures under the Medicare Physician Fee Schedule for the technical component. The HOPPS Final Rule would have had a negative impact on these procedures in both hospital and office-based settings.

In order to inform CMS about how devastating these cuts would be, the SVS Washington office organized a grassroots effort, which included a letter to CMS from members of Congress who are physicians along with a personal call from Rep. Bucshon, MD (R-IN) to CMS Administrator Seema Verma and letters from many SVS members who described the personal impact of these cuts. Both of these activities were instrumental in CMS issuing the correction notice.

For more background, read the December eblast seeking comments from SVS members on the proposed imaging cuts.