07/13/2022    Paul Kesselman, DPM

CMS Pitches Physician Payment Decrease for 2023

In addition to the payment decrease for 2023, CMS
is proposing a disastrous revamping of the
reimbursement for cellular tissue products in 2024.
CMS stated intent is to discontinue the use of "Q"
codes for all CTP and reinvent them as "A" codes.
These "A" codes would then be considered incidental
to the provision of the appropriate CPT code.

The complexity and unconscionable absurdness of
this proposal is beyond anything I have seen in the
forty plus years I have been following CMS policy.
This policy will cause undue harm to patients with
potential to devastate millions of lives. From the
outset and responsible use of CTP, I have seen the
difference the CTP has made for many patients.
This proposal will make the provision of CTP
uneconomical for most providers on an outpatient
basis. In hospital treatment for these types of
wounds often is unwarranted and if made mandatory,
will no doubt cost far more.

The noteworthy intent of CMS is to save money and
as a taxpayer and responsible provider I have to
applaud that. However, the current proposal will
result in accessibility to care issues for many
patients. Instead I would suggest that CMS instruct
the MAC to:

1) Reinstate rather than withdraw their CTP LCD and
LCA with far more stringent regulations. Some
recently withdrawn policies had A1C of 10 or 14.
That is totally irresponsible.

Furthermore the MAC should have a single NCD across
the country rather than have a hodgepodge of
policies which often conflict with one another.
Some are far too liberal some far too conservative.

2) The coordinated policy should be approved by
wound care experts and not carrier medical
directors and staff who are in specialties with
little to no expertise in wound care.

3) Develop prior authorization guidelines similar
to those needed for certain DMEPOS. The turnaround
time is usually less than a few days for those
targeted O/P devices. As with the
DMEPOS policy, if a CTP is needed urgently and
cannot wait, simply have the claim subject to pre-
payment review. That exact system has worked very
well in the O/P world.

These 3 proposals make far more logical sense and
will cost the government far less than the
unintended consequence of the current proposal.

Additionally how is CMS to account for wastage, the
variety of pricing structures of the various CTP?
Additional modifiers, total exclusion of the actual
cost for these expensive but limb-saving products?
These are not responsible answers and will confuse
both providers and their billing staff. If ever
there was a proposal to stifle innovation, and cost
lives the current CMS proposal will certainly do
that.

There is a 60-day window to respond. I would urge
every podiatrist, whether involved in wound care or
not, to speak with their other medical colleagues
about this proposal and the unintended consequences
this may have. I would also urge APMA to coordinate
a strong response to CMS with every other
stakeholders, including APWH, APWCA, SVS, etc.

More information on this can be found in the 2023
proposed MCR physician fee schedule available at:
Fed Register MCR Physician Fee Schedule 2023
https://www.federalregister.gov/public-
inspection/2022-14562/medicare-and-medicaid-
programs-calendar-year-2023-payment-policies-under-
the-physician-fee-schedule

and CMS FACT SHEET Calendar Year 2023 MCR Physician
Fee Schedule Proposed Rule
https://www.cms.gov/newsroom/fact-sheets/calendar-
year-cy-2023-medicare-physician-fee-schedule-
proposed-rule

Paul Kesselman, DPM, Oceanside, NY

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