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Protect the next generation of GI investigators
Investing in research is the only way we will identify new diagnostics and treatments. However, at this time of unparalleled scientific and clinical opportunity, promising early stage investigators are leaving the field because of the instability of federal research funding.
Fortunately, the AGA Research Foundation has a proven track record of funding young investigators whose work advances the field of gastroenterology and hepatology.
Help the AGA build a community of investigators through the AGA Research Foundation.
Your donation to the AGA Research Foundation can fund future success stories by keeping young scientists working to advance our understanding of digestive diseases.
Donate today to help protect the GI research pipeline. Make a tax-deductible donation at www.foundation.gastro.org.
Investing in research is the only way we will identify new diagnostics and treatments. However, at this time of unparalleled scientific and clinical opportunity, promising early stage investigators are leaving the field because of the instability of federal research funding.
Fortunately, the AGA Research Foundation has a proven track record of funding young investigators whose work advances the field of gastroenterology and hepatology.
Help the AGA build a community of investigators through the AGA Research Foundation.
Your donation to the AGA Research Foundation can fund future success stories by keeping young scientists working to advance our understanding of digestive diseases.
Donate today to help protect the GI research pipeline. Make a tax-deductible donation at www.foundation.gastro.org.
Investing in research is the only way we will identify new diagnostics and treatments. However, at this time of unparalleled scientific and clinical opportunity, promising early stage investigators are leaving the field because of the instability of federal research funding.
Fortunately, the AGA Research Foundation has a proven track record of funding young investigators whose work advances the field of gastroenterology and hepatology.
Help the AGA build a community of investigators through the AGA Research Foundation.
Your donation to the AGA Research Foundation can fund future success stories by keeping young scientists working to advance our understanding of digestive diseases.
Donate today to help protect the GI research pipeline. Make a tax-deductible donation at www.foundation.gastro.org.
Reforming prior authorization remains AGA’s top policy priority
Reforming prior authorization polices to reduce red tape for physicians and help patients get the care they need in a timely manner is the AGA’s number one policy priority as it impacts every gastroenterologist regardless of practice setting. We have seen an increase in prior authorization policies from every major insurer. The most recent prior authorization program to impact gastroenterologists was announced by UnitedHealthcare (UHC) in March for implementation on June 1, 2023 and will require prior authorization for most colonoscopy and upper GI endoscopy procedures with the exception of screening colonoscopy.1 This policy is a step back at a time when payers should be developing innovative policies in collaboration with health care providers to improve patient care.
UHC’s GI prior authorization policy
AGA met with UHC in March to discuss their plan to require prior authorization for most GI endoscopy procedures. We stressed how this change will cause care delays for high-risk individuals, deter patients from undergoing medically recommended procedures, exacerbate existing sociodemographic disparities in care and outcomes, and add unnecessary paperwork burden to physicians who have mounting rates of burnout.
Linda Lee, MD, medical director of endoscopy at Brigham and Women’s Hospital, Boston, recently spoke of the impact this policy will have on gastroenterologists and their patients. “We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each health care provider’s practice, because we need people to fill out these prior authorization forms, waste time trying to get through to their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical knowledge about why these procedures are necessary.”
However, Dr. Lee stressed that “most importantly, this will lead to poorer patient care with delays in care as we are struggling to wade through the morass of prior authorization while patients are bleeding, not able to swallow, vomiting, and more while waiting for their insurance company to approve their potentially life-saving procedures.”
We were particularly troubled that UHC announced this policy during Colorectal Cancer Awareness Month, given the need to screen more Americans for colorectal cancer which remains the nation’s number two cancer killer. The UHC program would require a PA on surveillance colonoscopy for those patients who have previously had polyps removed and are at a higher risk for developing colorectal cancer.
“We know that patients with high-risk adenomas or advanced sessile serrated lesions have a higher risk of developing colorectal cancer and timely access to the necessary surveillance colonoscopy is critical,” said David Lieberman, MD, past president of the AGA and chair of the AGA Executive Committee on the Screening Continuum.
AGA plans to meet with UHC again to ask them to reconsider this policy, but we need your advocacy now to tell United how this will impact you and your patients.
How you can help stop UHC’s prior authorization program
Write to UHC: Tell UHC how this policy would impact you and your patients. Contact their CEO using our customizable letter2 that outlines the impact of United’s GI endoscopy prior authorization program on gastroenterologists and their patients available on the AGA Advocacy Action Center.
Use social media: Tag United (@UHC) on Twitter and tell them how this burdensome program will cause delays for high-risk individuals, deter patients from seeking treatment, and exacerbate existing disparities in care, all while saddling physicians with even more paperwork. Once you’ve tweeted, tag your colleagues and encourage them to get involved.
AGA is working to reform prior authorization
The AGA has supported federal legislation that would streamline prior authorization processes in Medicare Advantage (MA), the private insurance plans that contract with the Medicare program, given the explosion of these policies over the past several years. The Improving Seniors Timely Access to Care Act, bipartisan, bicameral legislation, would reduce prior authorization burdens by:
- Establishing an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities.
- Requiring the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program.
- Standardizing and streamlining the prior authorization process for routinely approved items and services.
- Ensuring prior authorization requests are reviewed by qualified medical personnel.
- Increasing transparency around MA prior authorization requirements and their use.
- Protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
The Centers for Medicare & Medicaid Services (CMS) has also recognized the impact that prior authorization is having on physician wellness and how it is contributing to physician burnout. The agency recently proposed implementing many of the provisions that are outlined in the legislation, and AGA has expressed our support for moving forward with many of their proposals.
Earlier this year, Shivan Mehta, MD, MPH, met with CMS administrator Chiquita Brooks-LaSure and Surgeon General Vivek Murthy, MD, MBA, to express AGA’s support for prior authorization reform and discussed how it impacts how patients with chronic conditions like inflammatory bowel disease maintain continuity of care. He also stressed how prior authorization further exacerbates health inequities since it creates an additional barrier to care when barriers already exist.
AGA is taking a multi-pronged approach to advocating for prior authorization reform and reducing paperwork through legislative advocacy, regulatory advocacy with the CMS, and payer advocacy. We can’t do this alone. Join our AGA Advocacy Center3 and get involved in our AGA Congressional Advocates Program.4The authors have no conflicts to declare.
References
1. UnitedHealthcare (2023 Mar 01) New requirements for gastroenterology services.
2. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Tell United to Stop New Prior Auth Requirements!
3. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Advocacy & Policy. Get Involved.
4. American Gastroenterological Association (n.d.) AGA Congressional Advocates Program.
Reforming prior authorization polices to reduce red tape for physicians and help patients get the care they need in a timely manner is the AGA’s number one policy priority as it impacts every gastroenterologist regardless of practice setting. We have seen an increase in prior authorization policies from every major insurer. The most recent prior authorization program to impact gastroenterologists was announced by UnitedHealthcare (UHC) in March for implementation on June 1, 2023 and will require prior authorization for most colonoscopy and upper GI endoscopy procedures with the exception of screening colonoscopy.1 This policy is a step back at a time when payers should be developing innovative policies in collaboration with health care providers to improve patient care.
UHC’s GI prior authorization policy
AGA met with UHC in March to discuss their plan to require prior authorization for most GI endoscopy procedures. We stressed how this change will cause care delays for high-risk individuals, deter patients from undergoing medically recommended procedures, exacerbate existing sociodemographic disparities in care and outcomes, and add unnecessary paperwork burden to physicians who have mounting rates of burnout.
Linda Lee, MD, medical director of endoscopy at Brigham and Women’s Hospital, Boston, recently spoke of the impact this policy will have on gastroenterologists and their patients. “We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each health care provider’s practice, because we need people to fill out these prior authorization forms, waste time trying to get through to their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical knowledge about why these procedures are necessary.”
However, Dr. Lee stressed that “most importantly, this will lead to poorer patient care with delays in care as we are struggling to wade through the morass of prior authorization while patients are bleeding, not able to swallow, vomiting, and more while waiting for their insurance company to approve their potentially life-saving procedures.”
We were particularly troubled that UHC announced this policy during Colorectal Cancer Awareness Month, given the need to screen more Americans for colorectal cancer which remains the nation’s number two cancer killer. The UHC program would require a PA on surveillance colonoscopy for those patients who have previously had polyps removed and are at a higher risk for developing colorectal cancer.
“We know that patients with high-risk adenomas or advanced sessile serrated lesions have a higher risk of developing colorectal cancer and timely access to the necessary surveillance colonoscopy is critical,” said David Lieberman, MD, past president of the AGA and chair of the AGA Executive Committee on the Screening Continuum.
AGA plans to meet with UHC again to ask them to reconsider this policy, but we need your advocacy now to tell United how this will impact you and your patients.
How you can help stop UHC’s prior authorization program
Write to UHC: Tell UHC how this policy would impact you and your patients. Contact their CEO using our customizable letter2 that outlines the impact of United’s GI endoscopy prior authorization program on gastroenterologists and their patients available on the AGA Advocacy Action Center.
Use social media: Tag United (@UHC) on Twitter and tell them how this burdensome program will cause delays for high-risk individuals, deter patients from seeking treatment, and exacerbate existing disparities in care, all while saddling physicians with even more paperwork. Once you’ve tweeted, tag your colleagues and encourage them to get involved.
AGA is working to reform prior authorization
The AGA has supported federal legislation that would streamline prior authorization processes in Medicare Advantage (MA), the private insurance plans that contract with the Medicare program, given the explosion of these policies over the past several years. The Improving Seniors Timely Access to Care Act, bipartisan, bicameral legislation, would reduce prior authorization burdens by:
- Establishing an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities.
- Requiring the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program.
- Standardizing and streamlining the prior authorization process for routinely approved items and services.
- Ensuring prior authorization requests are reviewed by qualified medical personnel.
- Increasing transparency around MA prior authorization requirements and their use.
- Protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
The Centers for Medicare & Medicaid Services (CMS) has also recognized the impact that prior authorization is having on physician wellness and how it is contributing to physician burnout. The agency recently proposed implementing many of the provisions that are outlined in the legislation, and AGA has expressed our support for moving forward with many of their proposals.
Earlier this year, Shivan Mehta, MD, MPH, met with CMS administrator Chiquita Brooks-LaSure and Surgeon General Vivek Murthy, MD, MBA, to express AGA’s support for prior authorization reform and discussed how it impacts how patients with chronic conditions like inflammatory bowel disease maintain continuity of care. He also stressed how prior authorization further exacerbates health inequities since it creates an additional barrier to care when barriers already exist.
AGA is taking a multi-pronged approach to advocating for prior authorization reform and reducing paperwork through legislative advocacy, regulatory advocacy with the CMS, and payer advocacy. We can’t do this alone. Join our AGA Advocacy Center3 and get involved in our AGA Congressional Advocates Program.4The authors have no conflicts to declare.
References
1. UnitedHealthcare (2023 Mar 01) New requirements for gastroenterology services.
2. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Tell United to Stop New Prior Auth Requirements!
3. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Advocacy & Policy. Get Involved.
4. American Gastroenterological Association (n.d.) AGA Congressional Advocates Program.
Reforming prior authorization polices to reduce red tape for physicians and help patients get the care they need in a timely manner is the AGA’s number one policy priority as it impacts every gastroenterologist regardless of practice setting. We have seen an increase in prior authorization policies from every major insurer. The most recent prior authorization program to impact gastroenterologists was announced by UnitedHealthcare (UHC) in March for implementation on June 1, 2023 and will require prior authorization for most colonoscopy and upper GI endoscopy procedures with the exception of screening colonoscopy.1 This policy is a step back at a time when payers should be developing innovative policies in collaboration with health care providers to improve patient care.
UHC’s GI prior authorization policy
AGA met with UHC in March to discuss their plan to require prior authorization for most GI endoscopy procedures. We stressed how this change will cause care delays for high-risk individuals, deter patients from undergoing medically recommended procedures, exacerbate existing sociodemographic disparities in care and outcomes, and add unnecessary paperwork burden to physicians who have mounting rates of burnout.
Linda Lee, MD, medical director of endoscopy at Brigham and Women’s Hospital, Boston, recently spoke of the impact this policy will have on gastroenterologists and their patients. “We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each health care provider’s practice, because we need people to fill out these prior authorization forms, waste time trying to get through to their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical knowledge about why these procedures are necessary.”
However, Dr. Lee stressed that “most importantly, this will lead to poorer patient care with delays in care as we are struggling to wade through the morass of prior authorization while patients are bleeding, not able to swallow, vomiting, and more while waiting for their insurance company to approve their potentially life-saving procedures.”
We were particularly troubled that UHC announced this policy during Colorectal Cancer Awareness Month, given the need to screen more Americans for colorectal cancer which remains the nation’s number two cancer killer. The UHC program would require a PA on surveillance colonoscopy for those patients who have previously had polyps removed and are at a higher risk for developing colorectal cancer.
“We know that patients with high-risk adenomas or advanced sessile serrated lesions have a higher risk of developing colorectal cancer and timely access to the necessary surveillance colonoscopy is critical,” said David Lieberman, MD, past president of the AGA and chair of the AGA Executive Committee on the Screening Continuum.
AGA plans to meet with UHC again to ask them to reconsider this policy, but we need your advocacy now to tell United how this will impact you and your patients.
How you can help stop UHC’s prior authorization program
Write to UHC: Tell UHC how this policy would impact you and your patients. Contact their CEO using our customizable letter2 that outlines the impact of United’s GI endoscopy prior authorization program on gastroenterologists and their patients available on the AGA Advocacy Action Center.
Use social media: Tag United (@UHC) on Twitter and tell them how this burdensome program will cause delays for high-risk individuals, deter patients from seeking treatment, and exacerbate existing disparities in care, all while saddling physicians with even more paperwork. Once you’ve tweeted, tag your colleagues and encourage them to get involved.
AGA is working to reform prior authorization
The AGA has supported federal legislation that would streamline prior authorization processes in Medicare Advantage (MA), the private insurance plans that contract with the Medicare program, given the explosion of these policies over the past several years. The Improving Seniors Timely Access to Care Act, bipartisan, bicameral legislation, would reduce prior authorization burdens by:
- Establishing an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities.
- Requiring the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program.
- Standardizing and streamlining the prior authorization process for routinely approved items and services.
- Ensuring prior authorization requests are reviewed by qualified medical personnel.
- Increasing transparency around MA prior authorization requirements and their use.
- Protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
The Centers for Medicare & Medicaid Services (CMS) has also recognized the impact that prior authorization is having on physician wellness and how it is contributing to physician burnout. The agency recently proposed implementing many of the provisions that are outlined in the legislation, and AGA has expressed our support for moving forward with many of their proposals.
Earlier this year, Shivan Mehta, MD, MPH, met with CMS administrator Chiquita Brooks-LaSure and Surgeon General Vivek Murthy, MD, MBA, to express AGA’s support for prior authorization reform and discussed how it impacts how patients with chronic conditions like inflammatory bowel disease maintain continuity of care. He also stressed how prior authorization further exacerbates health inequities since it creates an additional barrier to care when barriers already exist.
AGA is taking a multi-pronged approach to advocating for prior authorization reform and reducing paperwork through legislative advocacy, regulatory advocacy with the CMS, and payer advocacy. We can’t do this alone. Join our AGA Advocacy Center3 and get involved in our AGA Congressional Advocates Program.4The authors have no conflicts to declare.
References
1. UnitedHealthcare (2023 Mar 01) New requirements for gastroenterology services.
2. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Tell United to Stop New Prior Auth Requirements!
3. American Gastroenterological Association (n.d.) AGA Advocacy Action Center. Advocacy & Policy. Get Involved.
4. American Gastroenterological Association (n.d.) AGA Congressional Advocates Program.
New AGA guideline recommends blood and stool tests for monitoring ulcerative colitis
These guidelines were published in Gastroenterology.
The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool). AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms.
Patients with UC in symptomatic remission
- Perform interval biomarker monitoring every 6-12 months.
- AGA recommends stool-based biomarkers over blood testing.
- If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.
- If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.
- Listen to your body! Talk to your doctor about any new symptoms.
Patients with symptomatically active UC
- Biomarker testing should be the first step to determine the need for endoscopic assessment.
- For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
- For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
- For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.
With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients.
AGA will advocate for all insurers to cover the cost of biomarker testing in UC.
These guidelines were published in Gastroenterology.
The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool). AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms.
Patients with UC in symptomatic remission
- Perform interval biomarker monitoring every 6-12 months.
- AGA recommends stool-based biomarkers over blood testing.
- If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.
- If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.
- Listen to your body! Talk to your doctor about any new symptoms.
Patients with symptomatically active UC
- Biomarker testing should be the first step to determine the need for endoscopic assessment.
- For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
- For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
- For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.
With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients.
AGA will advocate for all insurers to cover the cost of biomarker testing in UC.
These guidelines were published in Gastroenterology.
The AGA guidelines outline use cases for three biomarkers that provide accurate insights into UC disease activity: serum C-reactive protein (CRP) (blood), fecal calprotectin (stool), and fecal lactoferrin (stool). AGA recommends a monitoring strategy that integrates noninvasive biomarkers for patients with UC in remission (no current symptoms) as well as those with current symptoms.
Patients with UC in symptomatic remission
- Perform interval biomarker monitoring every 6-12 months.
- AGA recommends stool-based biomarkers over blood testing.
- If biomarkers are normal, AGA suggests continuing biomarker monitoring and avoiding routine endoscopic assessment.
- If biomarkers are elevated, AGA suggests endoscopic assessment by a gastroenterologist.
- Listen to your body! Talk to your doctor about any new symptoms.
Patients with symptomatically active UC
- Biomarker testing should be the first step to determine the need for endoscopic assessment.
- For patients with mild symptoms who have normal or elevated biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
- For patients with moderate to severe symptoms who have normal biomarkers, AGA suggests endoscopic assessment by a gastroenterologist.
- For patients with moderate to severe symptoms and elevated biomarkers, AGA suggests treatment adjustment and avoiding endoscopic assessment.
With AGA guidelines guiding the use of noninvasive biomarkers, physicians can confidently offer a more convenient and closer monitoring option for their patients.
AGA will advocate for all insurers to cover the cost of biomarker testing in UC.
Medicare requires new modifier for CRC follow-on colonoscopy claims
To unlock this free benefit, providers must properly apply modifier KX.
What codes does this apply to?
Providers must append modifier KX (“requirements specified in the medical policy have been met”) to HCPCS codes G0105 and G0121 when the screening colonoscopy follows a positive result from one of the following noninvasive stool-based CRC screening tests:
- Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (CPT 82270).
- Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (HCPCS G0328).
- Cologuard™ – Multi-target Stool DNA (sDNA) Test (CPT 81528).
What happens if I don’t use the KX modifier?
Medicare will return the screening colonoscopy claim as “unprocessable” and you will receive one of following messages:
CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)”
or
RARC N823: “Incomplete/Invalid Procedure Modifier”
Attach modifier KX and resubmit the claim to Medicare.
Should I use modifier KX if I remove polyps?
No. If you remove polyps during a screening colonoscopy following a positive noninvasive stool-based test, report the appropriate CPT code (for example, 45380, 45384, 45385, or 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare.
Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet when polypectomy is needed during a screening colonoscopy. Medicare beneficiary coinsurance responsibility is 15% of the cost of the procedure from 2023 to 2026. The coinsurance responsibility falls to 10% from 2027 to 2029 and by 2030 it will be covered 100% by Medicare.
Where can I find more information?
See the MLN Matters notice and the CMS Manual System.
To unlock this free benefit, providers must properly apply modifier KX.
What codes does this apply to?
Providers must append modifier KX (“requirements specified in the medical policy have been met”) to HCPCS codes G0105 and G0121 when the screening colonoscopy follows a positive result from one of the following noninvasive stool-based CRC screening tests:
- Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (CPT 82270).
- Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (HCPCS G0328).
- Cologuard™ – Multi-target Stool DNA (sDNA) Test (CPT 81528).
What happens if I don’t use the KX modifier?
Medicare will return the screening colonoscopy claim as “unprocessable” and you will receive one of following messages:
CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)”
or
RARC N823: “Incomplete/Invalid Procedure Modifier”
Attach modifier KX and resubmit the claim to Medicare.
Should I use modifier KX if I remove polyps?
No. If you remove polyps during a screening colonoscopy following a positive noninvasive stool-based test, report the appropriate CPT code (for example, 45380, 45384, 45385, or 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare.
Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet when polypectomy is needed during a screening colonoscopy. Medicare beneficiary coinsurance responsibility is 15% of the cost of the procedure from 2023 to 2026. The coinsurance responsibility falls to 10% from 2027 to 2029 and by 2030 it will be covered 100% by Medicare.
Where can I find more information?
See the MLN Matters notice and the CMS Manual System.
To unlock this free benefit, providers must properly apply modifier KX.
What codes does this apply to?
Providers must append modifier KX (“requirements specified in the medical policy have been met”) to HCPCS codes G0105 and G0121 when the screening colonoscopy follows a positive result from one of the following noninvasive stool-based CRC screening tests:
- Screening Guaiac-based Fecal Occult Blood Test (gFOBT) (CPT 82270).
- Screening Immunoassay-based Fecal Occult Blood Test (iFOBT) (HCPCS G0328).
- Cologuard™ – Multi-target Stool DNA (sDNA) Test (CPT 81528).
What happens if I don’t use the KX modifier?
Medicare will return the screening colonoscopy claim as “unprocessable” and you will receive one of following messages:
CARC 16: “Claim/service lacks information or has submission billing error(s)” and RARC N822: “Missing Procedure Modifier(s)”
or
RARC N823: “Incomplete/Invalid Procedure Modifier”
Attach modifier KX and resubmit the claim to Medicare.
Should I use modifier KX if I remove polyps?
No. If you remove polyps during a screening colonoscopy following a positive noninvasive stool-based test, report the appropriate CPT code (for example, 45380, 45384, 45385, or 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare.
Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet when polypectomy is needed during a screening colonoscopy. Medicare beneficiary coinsurance responsibility is 15% of the cost of the procedure from 2023 to 2026. The coinsurance responsibility falls to 10% from 2027 to 2029 and by 2030 it will be covered 100% by Medicare.
Where can I find more information?
See the MLN Matters notice and the CMS Manual System.
A gift in your will: Getting started
A simple, flexible, and versatile way to ensure the AGA Research Foundation can continue our work for years to come is a gift in your will or living trust, known as a charitable bequest. To make a charitable bequest, you need a current will or living trust.
After your lifetime, the AGA Research Foundation receives your gift.
We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise, and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”
When planning a future gift, it’s sometimes difficult to determine what size donation will make sense. Emergencies happen, and you need to make sure your family is financially taken care of first. Including a bequest of a percentage of your estate ensures that your gift will remain proportionate no matter how your estate’s value fluctuates over the years.
Whether you would like to put your donation to work today or benefit us after your lifetime, you can find a charitable plan that lets you provide for your family and support the AGA Research Foundation.
Please contact us for more information at [email protected] or visit gastro.planmylegacy.org.
A simple, flexible, and versatile way to ensure the AGA Research Foundation can continue our work for years to come is a gift in your will or living trust, known as a charitable bequest. To make a charitable bequest, you need a current will or living trust.
After your lifetime, the AGA Research Foundation receives your gift.
We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise, and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”
When planning a future gift, it’s sometimes difficult to determine what size donation will make sense. Emergencies happen, and you need to make sure your family is financially taken care of first. Including a bequest of a percentage of your estate ensures that your gift will remain proportionate no matter how your estate’s value fluctuates over the years.
Whether you would like to put your donation to work today or benefit us after your lifetime, you can find a charitable plan that lets you provide for your family and support the AGA Research Foundation.
Please contact us for more information at [email protected] or visit gastro.planmylegacy.org.
A simple, flexible, and versatile way to ensure the AGA Research Foundation can continue our work for years to come is a gift in your will or living trust, known as a charitable bequest. To make a charitable bequest, you need a current will or living trust.
After your lifetime, the AGA Research Foundation receives your gift.
We hope you’ll consider including a gift to the AGA Research Foundation in your will or living trust. It’s simple – just a few sentences in your will or trust are all that is needed. The official bequest language for the AGA Research Foundation is: “I, [name], of [city, state, ZIP], give, devise, and bequeath to the AGA Research Foundation [written amount or percentage of the estate or description of property] for its unrestricted use and purpose.”
When planning a future gift, it’s sometimes difficult to determine what size donation will make sense. Emergencies happen, and you need to make sure your family is financially taken care of first. Including a bequest of a percentage of your estate ensures that your gift will remain proportionate no matter how your estate’s value fluctuates over the years.
Whether you would like to put your donation to work today or benefit us after your lifetime, you can find a charitable plan that lets you provide for your family and support the AGA Research Foundation.
Please contact us for more information at [email protected] or visit gastro.planmylegacy.org.
New coding policies to prevent surprise billing for CRC screening
The Departments of Labor, Health & Human Services, and the Treasury issued guidance in 2022 that plans and insurers “must cover and may not impose cost sharing with respect to a colonoscopy conducted after a positive non-invasive stool-based screening test” for plan or policy years1 beginning on or after May 31, 2022, and, further, “may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure.”2 So why are so many patients still being charged fees for these screening services? In many cases, the answer comes down to missing code modifiers.
Commercial insurers want you to use modifier 33
AGA spoke to Elevance (formerly Anthem), Cigna, Aetna, and Blue Cross Blue Shield Association about how physicians should report colorectal cancer screening procedures and tests. They said using the 33 modifier (preventive service) is essential for their systems to trigger the screening benefits for beneficiaries. Without the 33 modifier, the claim will be processed as a diagnostic service, and coinsurance may apply.
According to the CPT manual, modifier 33 should be used “when the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive mandates (legislative or regulatory) ...” Use modifier 33 with colonoscopies that start out as screening procedures and with colonoscopies following a positive non-invasive stool-based test, like fecal immunochemical test (FIT) or Cologuard™ multi-target stool DNA test.
It is important to note that modifier 33 won’t ensure all screening colonoscopy claims are paid, because not all commercial plans are required to cover 100 percent of the costs of CRC screening tests and procedures. For example, employer-sponsored insurance plans and legacy plans can choose not to adopt the expanded CRC benefits. Patients who are covered under these plans may not be aware that their CRC test or procedure will not be fully covered. These patients may still receive a “surprise” bill if their screening colonoscopy requires removal of polyps or if they have a colonoscopy following a positive non-invasive CRC test.
Medicare wants you to use modifiers PT and KX, but not together
CMS uses Healthcare Common Procedural Coding System (HCPCS) codes to differentiate between screening and diagnostic colonoscopies to apply screening benefits. For Medicare beneficiaries who choose colonoscopy as their CRC screening, use HCPCS code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or G0121 (Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk) for screening colonoscopies as appropriate. No modifier is necessary with G0105 or G0121.
Effective for claims with dates of service on or after 1/1/2023, use the appropriate HCPCS codes G0105 or G0121 with the KX modifier for colonoscopy following a positive result for any of the following non-invasive stool-based CRC screening tests:
• Screening guaiac-based fecal occult blood test (gFOBT) (CPT 82270)
• Screening immunoassay-based fecal occult blood test (iFOBT) (HCPCS G0328)
• Cologuard™ – multi-target stool DNA (sDNA) test (CPT 81528)
According to the guidance in the CMS Manual System, if modifier KX is not added to G0105 or G0121 for colonoscopy following a positive non-invasive stool-based test, Medicare will return the screening colonoscopy claim as “unprocessable.”3 If this happens, add modifier KX and resubmit the claim.
If polyps are removed during a screening colonoscopy, use the appropriate CPT code (45380, 45384, 45385, 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare. However, it is important to note that if a polyp is removed during a screening colonoscopy, the Medicare beneficiary is responsible for 15% of the cost from 2023 to 2026. This falls to 10% of the cost from 2027 to 2029, and by 2030 it will be covered 100% by Medicare. Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet.
What to do if your patient gets an unexpected bill
If your patient gets an unexpected bill and you coded the procedure correctly with the correct modifier, direct them to the AGA GI Patient Care Center’s “Colorectal cancer screening: what to expect when paying” resource for help with next steps.4
The authors have no conflicts to declare.
References
1. U.S. Department of Labor (2022, Jan. 10) FAQs About Affordable Care Act Implementation Part 51. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf
2. Centers for Medicare and Medicaid Services (n.d.) Affordable Care Act Implementation FAQs - Set 12. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.
3. Centers for Medicare and Medicaid Services (2023, Jan. 27) CMS Manual System Pub 100-03 Medicare National Coverage Determinations Transmittal 11824. https://www.cms.gov/files/document/r11824ncd.pdf.
4. American Gastroenterological Association (2023, Feb. 21) AGA GI Patient Center Colorectal Cancer Screening: What to expect when paying. https://patient.gastro.org/paying-for-your-colonoscopy/.
The Departments of Labor, Health & Human Services, and the Treasury issued guidance in 2022 that plans and insurers “must cover and may not impose cost sharing with respect to a colonoscopy conducted after a positive non-invasive stool-based screening test” for plan or policy years1 beginning on or after May 31, 2022, and, further, “may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure.”2 So why are so many patients still being charged fees for these screening services? In many cases, the answer comes down to missing code modifiers.
Commercial insurers want you to use modifier 33
AGA spoke to Elevance (formerly Anthem), Cigna, Aetna, and Blue Cross Blue Shield Association about how physicians should report colorectal cancer screening procedures and tests. They said using the 33 modifier (preventive service) is essential for their systems to trigger the screening benefits for beneficiaries. Without the 33 modifier, the claim will be processed as a diagnostic service, and coinsurance may apply.
According to the CPT manual, modifier 33 should be used “when the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive mandates (legislative or regulatory) ...” Use modifier 33 with colonoscopies that start out as screening procedures and with colonoscopies following a positive non-invasive stool-based test, like fecal immunochemical test (FIT) or Cologuard™ multi-target stool DNA test.
It is important to note that modifier 33 won’t ensure all screening colonoscopy claims are paid, because not all commercial plans are required to cover 100 percent of the costs of CRC screening tests and procedures. For example, employer-sponsored insurance plans and legacy plans can choose not to adopt the expanded CRC benefits. Patients who are covered under these plans may not be aware that their CRC test or procedure will not be fully covered. These patients may still receive a “surprise” bill if their screening colonoscopy requires removal of polyps or if they have a colonoscopy following a positive non-invasive CRC test.
Medicare wants you to use modifiers PT and KX, but not together
CMS uses Healthcare Common Procedural Coding System (HCPCS) codes to differentiate between screening and diagnostic colonoscopies to apply screening benefits. For Medicare beneficiaries who choose colonoscopy as their CRC screening, use HCPCS code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or G0121 (Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk) for screening colonoscopies as appropriate. No modifier is necessary with G0105 or G0121.
Effective for claims with dates of service on or after 1/1/2023, use the appropriate HCPCS codes G0105 or G0121 with the KX modifier for colonoscopy following a positive result for any of the following non-invasive stool-based CRC screening tests:
• Screening guaiac-based fecal occult blood test (gFOBT) (CPT 82270)
• Screening immunoassay-based fecal occult blood test (iFOBT) (HCPCS G0328)
• Cologuard™ – multi-target stool DNA (sDNA) test (CPT 81528)
According to the guidance in the CMS Manual System, if modifier KX is not added to G0105 or G0121 for colonoscopy following a positive non-invasive stool-based test, Medicare will return the screening colonoscopy claim as “unprocessable.”3 If this happens, add modifier KX and resubmit the claim.
If polyps are removed during a screening colonoscopy, use the appropriate CPT code (45380, 45384, 45385, 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare. However, it is important to note that if a polyp is removed during a screening colonoscopy, the Medicare beneficiary is responsible for 15% of the cost from 2023 to 2026. This falls to 10% of the cost from 2027 to 2029, and by 2030 it will be covered 100% by Medicare. Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet.
What to do if your patient gets an unexpected bill
If your patient gets an unexpected bill and you coded the procedure correctly with the correct modifier, direct them to the AGA GI Patient Care Center’s “Colorectal cancer screening: what to expect when paying” resource for help with next steps.4
The authors have no conflicts to declare.
References
1. U.S. Department of Labor (2022, Jan. 10) FAQs About Affordable Care Act Implementation Part 51. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf
2. Centers for Medicare and Medicaid Services (n.d.) Affordable Care Act Implementation FAQs - Set 12. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.
3. Centers for Medicare and Medicaid Services (2023, Jan. 27) CMS Manual System Pub 100-03 Medicare National Coverage Determinations Transmittal 11824. https://www.cms.gov/files/document/r11824ncd.pdf.
4. American Gastroenterological Association (2023, Feb. 21) AGA GI Patient Center Colorectal Cancer Screening: What to expect when paying. https://patient.gastro.org/paying-for-your-colonoscopy/.
The Departments of Labor, Health & Human Services, and the Treasury issued guidance in 2022 that plans and insurers “must cover and may not impose cost sharing with respect to a colonoscopy conducted after a positive non-invasive stool-based screening test” for plan or policy years1 beginning on or after May 31, 2022, and, further, “may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure.”2 So why are so many patients still being charged fees for these screening services? In many cases, the answer comes down to missing code modifiers.
Commercial insurers want you to use modifier 33
AGA spoke to Elevance (formerly Anthem), Cigna, Aetna, and Blue Cross Blue Shield Association about how physicians should report colorectal cancer screening procedures and tests. They said using the 33 modifier (preventive service) is essential for their systems to trigger the screening benefits for beneficiaries. Without the 33 modifier, the claim will be processed as a diagnostic service, and coinsurance may apply.
According to the CPT manual, modifier 33 should be used “when the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive mandates (legislative or regulatory) ...” Use modifier 33 with colonoscopies that start out as screening procedures and with colonoscopies following a positive non-invasive stool-based test, like fecal immunochemical test (FIT) or Cologuard™ multi-target stool DNA test.
It is important to note that modifier 33 won’t ensure all screening colonoscopy claims are paid, because not all commercial plans are required to cover 100 percent of the costs of CRC screening tests and procedures. For example, employer-sponsored insurance plans and legacy plans can choose not to adopt the expanded CRC benefits. Patients who are covered under these plans may not be aware that their CRC test or procedure will not be fully covered. These patients may still receive a “surprise” bill if their screening colonoscopy requires removal of polyps or if they have a colonoscopy following a positive non-invasive CRC test.
Medicare wants you to use modifiers PT and KX, but not together
CMS uses Healthcare Common Procedural Coding System (HCPCS) codes to differentiate between screening and diagnostic colonoscopies to apply screening benefits. For Medicare beneficiaries who choose colonoscopy as their CRC screening, use HCPCS code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or G0121 (Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk) for screening colonoscopies as appropriate. No modifier is necessary with G0105 or G0121.
Effective for claims with dates of service on or after 1/1/2023, use the appropriate HCPCS codes G0105 or G0121 with the KX modifier for colonoscopy following a positive result for any of the following non-invasive stool-based CRC screening tests:
• Screening guaiac-based fecal occult blood test (gFOBT) (CPT 82270)
• Screening immunoassay-based fecal occult blood test (iFOBT) (HCPCS G0328)
• Cologuard™ – multi-target stool DNA (sDNA) test (CPT 81528)
According to the guidance in the CMS Manual System, if modifier KX is not added to G0105 or G0121 for colonoscopy following a positive non-invasive stool-based test, Medicare will return the screening colonoscopy claim as “unprocessable.”3 If this happens, add modifier KX and resubmit the claim.
If polyps are removed during a screening colonoscopy, use the appropriate CPT code (45380, 45384, 45385, 45388) and add modifier PT (colorectal cancer screening test; converted to diagnostic test or other procedure) to each CPT code for Medicare. However, it is important to note that if a polyp is removed during a screening colonoscopy, the Medicare beneficiary is responsible for 15% of the cost from 2023 to 2026. This falls to 10% of the cost from 2027 to 2029, and by 2030 it will be covered 100% by Medicare. Some Medicare beneficiaries are not aware that Medicare has not fully eliminated the coinsurance responsibility yet.
What to do if your patient gets an unexpected bill
If your patient gets an unexpected bill and you coded the procedure correctly with the correct modifier, direct them to the AGA GI Patient Care Center’s “Colorectal cancer screening: what to expect when paying” resource for help with next steps.4
The authors have no conflicts to declare.
References
1. U.S. Department of Labor (2022, Jan. 10) FAQs About Affordable Care Act Implementation Part 51. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf
2. Centers for Medicare and Medicaid Services (n.d.) Affordable Care Act Implementation FAQs - Set 12. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.
3. Centers for Medicare and Medicaid Services (2023, Jan. 27) CMS Manual System Pub 100-03 Medicare National Coverage Determinations Transmittal 11824. https://www.cms.gov/files/document/r11824ncd.pdf.
4. American Gastroenterological Association (2023, Feb. 21) AGA GI Patient Center Colorectal Cancer Screening: What to expect when paying. https://patient.gastro.org/paying-for-your-colonoscopy/.
AGA’s GI Opportunity Fund invests in EndoSound®
EndoSound is an Oregon-based medical device innovator developing technology that enhances access, reduces costs, and increases the safety of endoscopic ultrasound (EUS) procedures.
The EndoSound Vision System® (EVS®) is a disruptive EUS platform. Its attachable transducer and supportive components transform a conventional upper endoscope into a fully functional endoscopic ultrasound device. The cost of existing EUS systems has limited the availability of this crucial modality in the United States and around the world.
By reducing this cost, the EVS will provide physicians with a technological option that can enable care for their patients in a greater number of locations and settings. This brings the potential for enormous benefits to patients, payers, and providers by reducing costs in the healthcare system.
EndoSound is an Oregon-based medical device innovator developing technology that enhances access, reduces costs, and increases the safety of endoscopic ultrasound (EUS) procedures.
The EndoSound Vision System® (EVS®) is a disruptive EUS platform. Its attachable transducer and supportive components transform a conventional upper endoscope into a fully functional endoscopic ultrasound device. The cost of existing EUS systems has limited the availability of this crucial modality in the United States and around the world.
By reducing this cost, the EVS will provide physicians with a technological option that can enable care for their patients in a greater number of locations and settings. This brings the potential for enormous benefits to patients, payers, and providers by reducing costs in the healthcare system.
EndoSound is an Oregon-based medical device innovator developing technology that enhances access, reduces costs, and increases the safety of endoscopic ultrasound (EUS) procedures.
The EndoSound Vision System® (EVS®) is a disruptive EUS platform. Its attachable transducer and supportive components transform a conventional upper endoscope into a fully functional endoscopic ultrasound device. The cost of existing EUS systems has limited the availability of this crucial modality in the United States and around the world.
By reducing this cost, the EVS will provide physicians with a technological option that can enable care for their patients in a greater number of locations and settings. This brings the potential for enormous benefits to patients, payers, and providers by reducing costs in the healthcare system.
A special tribute: Memorial and honorary gifts
Did you know you can honor a family member, friend, or colleague through a gift to the AGA Research Foundation?
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research, which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one.
- Named opportunities. Individuals interested in receiving name recognition for a listed AGA Institute program can do so by contributing a new, unrestricted gift to the AGA Research Foundation. The gift can be payable over five years. Endowed opportunities are also available.
Your next step
An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website.
Did you know you can honor a family member, friend, or colleague through a gift to the AGA Research Foundation?
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research, which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one.
- Named opportunities. Individuals interested in receiving name recognition for a listed AGA Institute program can do so by contributing a new, unrestricted gift to the AGA Research Foundation. The gift can be payable over five years. Endowed opportunities are also available.
Your next step
An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website.
Did you know you can honor a family member, friend, or colleague through a gift to the AGA Research Foundation?
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research, which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one.
- Named opportunities. Individuals interested in receiving name recognition for a listed AGA Institute program can do so by contributing a new, unrestricted gift to the AGA Research Foundation. The gift can be payable over five years. Endowed opportunities are also available.
Your next step
An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website.
What the omnibus bill means for GI
Here’s what you need to know:
Medicare payment cuts
Unfortunately, physicians treating Medicare patients will face cuts in the new year.
It is disappointing that Congress failed to stop the full cuts. However, the Medicare payment cuts will be lower than the initially proposed 8.5% cut. Physicians will face a 2% cut because of the 4% in PAYGO relief for 2023 and 2024, plus an additional 2.5% in relief for the Centers for Medicare & Medicaid Services.
This is not an ideal outcome, but we are grateful to the more than 160 AGA members who raised their voices and sent over 600 messages to Congress. Your advocacy played a role in alleviating the final number of the cuts.
We will continue to urge Congress to stop the full cuts. Our top priority in 2023 remains addressing the Medicare reimbursement rates.
Two-year extension for telehealth
Good news! We have been ongoing supporters of telehealth expansion that resulted from the COVID-19 pandemic. The inclusion of this 2-year telehealth extension will allow doctors to continue to treat Medicare patients in a virtual setting. This is crucial since it allows patients to continue receiving treatment from their doctor in a virtual setting, and it provides patients and providers with certainty.
$2.5 billion increase for NIH
Good news! The omnibus allocates $47.5 billion for the National Institutes of Health’s budget, a $2.5 billion increase from 2023. The increased federal research funding is something we advocated for with congressional offices during Advocacy Day and will support GI researchers who are conducting innovative research and developing treatment for digestive diseases and GI cancers.
AGA-submitted report language on IBD included
Good news! Two language requests submitted by AGA on inflammatory bowel disease (IBD) were included in the omnibus: one in the 2023 Department of Labor, Health and Human Services, Education and Related Agencies funding bill and one in the 2023 Department of Agriculture, Rural Development, Food and Drug Administration and Related Agencies funding bill.
The first reaffirms the Appropriations Committee’s support for the NIH in funding basic, translational, and clinical studies on the diagnosis and treatment of IBD. The second encourages the FDA to improve diversity and patient-centricity in IBD clinical trials. The inclusion of these language requests in the omnibus highlights another successful advocacy effort by AGA.
Here’s what you need to know:
Medicare payment cuts
Unfortunately, physicians treating Medicare patients will face cuts in the new year.
It is disappointing that Congress failed to stop the full cuts. However, the Medicare payment cuts will be lower than the initially proposed 8.5% cut. Physicians will face a 2% cut because of the 4% in PAYGO relief for 2023 and 2024, plus an additional 2.5% in relief for the Centers for Medicare & Medicaid Services.
This is not an ideal outcome, but we are grateful to the more than 160 AGA members who raised their voices and sent over 600 messages to Congress. Your advocacy played a role in alleviating the final number of the cuts.
We will continue to urge Congress to stop the full cuts. Our top priority in 2023 remains addressing the Medicare reimbursement rates.
Two-year extension for telehealth
Good news! We have been ongoing supporters of telehealth expansion that resulted from the COVID-19 pandemic. The inclusion of this 2-year telehealth extension will allow doctors to continue to treat Medicare patients in a virtual setting. This is crucial since it allows patients to continue receiving treatment from their doctor in a virtual setting, and it provides patients and providers with certainty.
$2.5 billion increase for NIH
Good news! The omnibus allocates $47.5 billion for the National Institutes of Health’s budget, a $2.5 billion increase from 2023. The increased federal research funding is something we advocated for with congressional offices during Advocacy Day and will support GI researchers who are conducting innovative research and developing treatment for digestive diseases and GI cancers.
AGA-submitted report language on IBD included
Good news! Two language requests submitted by AGA on inflammatory bowel disease (IBD) were included in the omnibus: one in the 2023 Department of Labor, Health and Human Services, Education and Related Agencies funding bill and one in the 2023 Department of Agriculture, Rural Development, Food and Drug Administration and Related Agencies funding bill.
The first reaffirms the Appropriations Committee’s support for the NIH in funding basic, translational, and clinical studies on the diagnosis and treatment of IBD. The second encourages the FDA to improve diversity and patient-centricity in IBD clinical trials. The inclusion of these language requests in the omnibus highlights another successful advocacy effort by AGA.
Here’s what you need to know:
Medicare payment cuts
Unfortunately, physicians treating Medicare patients will face cuts in the new year.
It is disappointing that Congress failed to stop the full cuts. However, the Medicare payment cuts will be lower than the initially proposed 8.5% cut. Physicians will face a 2% cut because of the 4% in PAYGO relief for 2023 and 2024, plus an additional 2.5% in relief for the Centers for Medicare & Medicaid Services.
This is not an ideal outcome, but we are grateful to the more than 160 AGA members who raised their voices and sent over 600 messages to Congress. Your advocacy played a role in alleviating the final number of the cuts.
We will continue to urge Congress to stop the full cuts. Our top priority in 2023 remains addressing the Medicare reimbursement rates.
Two-year extension for telehealth
Good news! We have been ongoing supporters of telehealth expansion that resulted from the COVID-19 pandemic. The inclusion of this 2-year telehealth extension will allow doctors to continue to treat Medicare patients in a virtual setting. This is crucial since it allows patients to continue receiving treatment from their doctor in a virtual setting, and it provides patients and providers with certainty.
$2.5 billion increase for NIH
Good news! The omnibus allocates $47.5 billion for the National Institutes of Health’s budget, a $2.5 billion increase from 2023. The increased federal research funding is something we advocated for with congressional offices during Advocacy Day and will support GI researchers who are conducting innovative research and developing treatment for digestive diseases and GI cancers.
AGA-submitted report language on IBD included
Good news! Two language requests submitted by AGA on inflammatory bowel disease (IBD) were included in the omnibus: one in the 2023 Department of Labor, Health and Human Services, Education and Related Agencies funding bill and one in the 2023 Department of Agriculture, Rural Development, Food and Drug Administration and Related Agencies funding bill.
The first reaffirms the Appropriations Committee’s support for the NIH in funding basic, translational, and clinical studies on the diagnosis and treatment of IBD. The second encourages the FDA to improve diversity and patient-centricity in IBD clinical trials. The inclusion of these language requests in the omnibus highlights another successful advocacy effort by AGA.
Fast facts about gifts in a will and planned giving
Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission to fund young investigators continues even after your lifetime.
#1. Wills are not for older adults only.
Having a plan for the future is important – no matter your age. A will makes your wishes known and provides your loved ones with peace of mind.
#2. Planned gifts are not complicated or confusing.
They don’t have to be. There are many types of planned gifts: Most are simple and affordable, like a gift in your will or living trust. You just need to find the one that best meets your needs.
#3. Planned gifts are not for the wealthy only.
Anyone can make a planned gift. Gifts of all sizes make a difference at the AGA Research Foundation. In fact, you may even be able to make a bigger impact than you thought possible when you make a planned gift.
For 2023, consider including a gift to the AGA Research Foundation in your will. You will help support researchers and help spark future discoveries in GI.
Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact us at [email protected].
Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission to fund young investigators continues even after your lifetime.
#1. Wills are not for older adults only.
Having a plan for the future is important – no matter your age. A will makes your wishes known and provides your loved ones with peace of mind.
#2. Planned gifts are not complicated or confusing.
They don’t have to be. There are many types of planned gifts: Most are simple and affordable, like a gift in your will or living trust. You just need to find the one that best meets your needs.
#3. Planned gifts are not for the wealthy only.
Anyone can make a planned gift. Gifts of all sizes make a difference at the AGA Research Foundation. In fact, you may even be able to make a bigger impact than you thought possible when you make a planned gift.
For 2023, consider including a gift to the AGA Research Foundation in your will. You will help support researchers and help spark future discoveries in GI.
Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact us at [email protected].
Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission to fund young investigators continues even after your lifetime.
#1. Wills are not for older adults only.
Having a plan for the future is important – no matter your age. A will makes your wishes known and provides your loved ones with peace of mind.
#2. Planned gifts are not complicated or confusing.
They don’t have to be. There are many types of planned gifts: Most are simple and affordable, like a gift in your will or living trust. You just need to find the one that best meets your needs.
#3. Planned gifts are not for the wealthy only.
Anyone can make a planned gift. Gifts of all sizes make a difference at the AGA Research Foundation. In fact, you may even be able to make a bigger impact than you thought possible when you make a planned gift.
For 2023, consider including a gift to the AGA Research Foundation in your will. You will help support researchers and help spark future discoveries in GI.
Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact us at [email protected].