Academy Submits Comments to CMS on Medicare Physician Fee Schedule

The CY 2027 Medicare Physician Fee Schedule proposed rule was released on July 14. The proposed rule has dozens of provisions relevant to our profession and we submitted comments on September 14.

The Academy's comments on the proposed rule could result in multiple wins for the profession. We propose over more than a dozen "asks" of CMS on behalf of our Academy members, some of which would be transformative for the profession, including:

The lifestyle codes that are being proposed could be a new funding mechanism that allows for new nutritional care services reimbursement that goes beyond MNT. The Academy has a table of codes that it is asking CMS to consider unlocking for payment to RDNs. If CMS allows any of these codes to be billed (for example, remote monitoring), it will be a big win for Academy members.

The rule proposes to replace the Indirect Practice Cost Index with a general-purpose Practice Expense Stabilization Adjustment that caps year-over-year PE RVU changes at 5% economy-wide. If finalized, there is a strong possibility that this provision results in RDNs experiencing a 5% reduction in PE RUV each year. Given the -1.68% conversion factor, RDNs are already experiencing cuts, and this would be additive.

The Academy proposes a set of non-E/M codes that RDNs should be allowed to bill, including lifestyle codes. We also mention some existing and some newly created E/M codes for which we request a parallel code. Since RDNs cannot bill E/M codes, we request a parallel code. For example, CMS creates a new code GSMAS for group shared medical appointments. We ask for a parallel code that we should be able to bill directly, not "incident to."

In two instances where new codes are created, the Academy asks to be able to bill these new codes for an extended list of conditions and diseases. The argument is that since they are not MNT codes, but a broader array of nutritional care services, we should be able to serve people with a wider variety of diseases because we are not constricted by MNT statutory restrictions.

The Academy will keep members apprised of any developments after the final regulation is released in a couple of months. The proposed regulation comments will serve as a cornerstone of the Academy's payment advocacy with CMS in the future, supplemented by comments to other Medicare payment regulations. The Academy also signed onto the letter for the Diabetes Advocacy Alliance (DAA).

View the Academy's comments