This week, AAHKS submitted comments on the Centers for Medicare & Medicaid Services’ (CMS) Medicare physician fee schedule (PFS) proposed rule for calendar year 2025. CMS has again proposed cuts to all physicians due to expiring temporary increases and decreases in conversion factor. With only an approximately 0.28% reduction in reimbursement for TJA services, this is still unacceptable and is leading to health care consolidation. For more, read our PFS letter.
Comments on the CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule for calendar year 2025 were also submitted this week. CMS proposes increases to the weights of the primary CPT codes associated with lower joint arthroplasty: 27447 and 27130. Combined with increases based on the proposed hospital inpatient market basket percentage of 2.6%, this leads to increases in Medicare OPPS payment rates for these arthroplasty codes. However, AAHKS continues to express concerns about increased facility payments while payment rates for the professional component of arthroplasty have been cut by nearly 11% since 2020. AAHKS specifically asks CMS to “explicitly state whether it believes that Medicare beneficiaries and the health care system are best served by rapidly increasing reimbursement rates to facilities for LEJR paired with severe cuts to the professional services for those procedures, and if so, why.” For more information, read our OPPS letter.
