s" a it "it. a, c, DEPARTMENT or HEALTH 3: HUMAN SERVICES MAR -5 lell we sil- Es t, 4 Centers tor Medicare it Medicaid Senn?ces Administrator Washington, DC 20201 The Honorable Tom Price U.S. House of Representatives Washington, DC 20515 Dear Representative Price: Thank you for your letter sharing your concerns regarding the recent changes related to physician payment for epidural injections. The Centers for Medicare Medicaid Services greatly appreciates your bringing these concerns to our attention. We understand that these changes will result in payment reductions and want to explain our rationale. These changes were made as part of our efforts to improve payment accuracy by reviewing potentially misvalued codes. We began this initiative in response to concerns raised by Congress, the Medicare Payment Advisory Commission and others. Potentially misvalued codes are reviewed with input from the American Medical Association! Specialty Society Resource?Based Relative Value Scale Update Committee (AMA RUC) and public stakeholders. Each year since 2009, we have identi?ed codes for review by looking for codes with speci?c attributes, such as those originally valued as inpatient services but that are typically furnished on an outpatient basis, services frequently billed together in one encounter, and high expenditure services that have not been recently reviewed. In our calendar year (CY) 2012 ?nal rule with comment period, we identi?ed epidural injection as a high expenditure service that had not been recently reviewed. In the CY 2014 ?nal rule with comment period, we established interim ?nal values for the epidural injection code family. In setting these values we used the survey times developed through the AMA RUC process. The interim ?nal revised work and practice expense values established in the CY 2014 ?nal rule with comment period reflect the reductions in time required to perform the service as a result of the surveys submitted with the AMA RUC-recommended values. We have adopted a process to consider and, as appropriate, revise values for codes that are considered as part of the potentially misvalued codes initiative. Under that process, we establish values for misvalued codes on an interim basis in the ?nal rule subject to public comment. We consider public comments on the interim ?nal values received in reSponse to the ?nal rule, and respond to those comments in the ?nal rule for the following year. In accordance with this process, we have established interim ?nal values for these epidural injection and spinal cord stimulation services, and we will consider public comments in establishing values for the codes in the ?nal rule for CY 2015. Page 2 The Honorable Tom Price We understand that this and other changes in the physician fee schedule are expected to result in some interim CY 2014 payment reductions for services previously identi?ed as potentially misvalued. However, we believe that it is critical to continue to re?ne Medicare payments to more accurately pay for physicians? services. I appreciate your interest in this important issue as we work towards our mutual goal of strengthening the Medicare program for all bene?ciaries. I will also provide this response to the co?signers of your letter. Sincerely, Wt Marilyn Tavenner 1533 Lowewonm House OFFICE WASHINGTON, 0.0. 20515 PHONE: 202.225.5311 ANDY HARRIS, MD. DISTRICT, MARYLAND 15 ROAD, 1028 BEL AIS, MARYLAND 21014 PHONE 410.588.5670 232 WEST MAIN STREET. SUITE 204B SALESBUHY, MARYLAND 21801 PHONE: 443.944.8624 COMMITTEE ON APPROPRIATIONS COMMERCE, JUSTICE, SCIENCE LABOR. HEALTH AND HUMAN SERVICES, 100 OLDE POENT Sum; 101 EDUCATION CHESTER, MARYLAND 21619 glimmer .ef ?Reprrasataithsa PHONE: 410-543-5425 LEGISLATIVE BRANCH Ir $61 413515 January 23, 2014 Marilyn Tavenner, Administrator Centers for Medicare 8: Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Marilyn.Tavenner@c.ms.hhs.gov Dear Administrator Tavenner: We, the undersigned members of the House GOP Doctors Caucus, are writing regarding the rules for physician payments, hospital outpatient and ambulatory surgical center payments, which were published on November 27, 2013 to be effective January 1, 2014. We are concerned this rule will impact beneficiaries? access to interventional pain management while driving patients to seek treatment in a more expensrve setting. Included in this ?nal rule was a cut to epidural injections with a 36% reduction for physician payment and 58% reduction for procedures performed in an of?ce setting. Speci?cally, we are concerned with Codes 62310, 62311, 62318, 62319. Unless CMS addresses the underpayment for these interventional pain management services as soon as possible, there is a major risk of bene?ciaries losing access to interventional pain physicians. We do not believe the policies proposed in the MFPS rules are in the best interest of patients or taxpayers and would urge you to overturn or delay the ?nal rule. Thank you for your attention to this important matter. Please contact Chris Meekins in Congressman Andy Harris? office if you have any questions. Sincerely, . Andy Harns, MD. Member of Congress