Medicine Fights Proposed Medicaid Specialty Care Cuts

Can we talk about CPT codes for a minute?

If you’re still reading, then you obviously care about CPT codes. If you don’t care about them, feel free to move on. 

As it does every two years, the Texas Health and Human Services Commission’s (HHSC's) Rate Analysis Department is reviewing CPT codes and making adjustments to the payments for those services. Sometimes, the payments go up, sometimes they go down, and sometimes they stay the same. Sunrise, sunset.

Well, this time, HHSC is proposing cuts in Medicaid payments for cardiovascular, gastroenterology, and robotic prostate surgery services. The problem is, practice costs are expected to increase in the coming years. That could be a problem for the ol’ financial department.

In response, TMA sent a letter to HHSC regarding proposed cuts to cardiology services. But that’s not all. TMA has also cosigned two more letters from the Texas Society for Gastroenterology and Endoscopy (TSGE) and the Texas Urological Society (TUS), who also are fighting the reductions.

TSGE opposes rate cuts of 1 percent to 4 percent for gastroenterology services, and TUS is pushing back against a proposed 16-percent reduction in robotic prostate reimbursement.

“These cuts add to the cumulative erosion of Medicaid payments and their failure to keep pace with the costs of running a practice,” the letters say.

The proposed changes could go into effect July 1 after HHSC reviews the comments. Stay tuned.

Action, June 1, 2017

Last Updated On

June 01, 2017

Related Content

Coding | Medicaid