On July 14, the Centers for Medicare and Medicaid Services (CMS) issued the 2027 proposed Medicare Physician Fee Schedule.

In this proposed rule, the agency is seeking comments on whether the surgical pathology code family is potentially misvalued, and whether action should be taken in 2027 or future rulemakings. This proposal is based on a recommendation from the Maryland Health Care Commission (MHCC) that overlooks critical pathology-specific coding, billing attribution, and data-quality issues, resulting in analyses that do not accurately represent pathology practice or resource utilization. This study is non transparent, potentially deeply flawed and not representative of the vast majority of pathology practices.

The CAP strongly urges you to contact CMS and communicate the importance of not making unilateral changes to surgical pathology services in CY 2027 based solely on the MHCC analysis. Specifically, the CAP recommends that CMS:

  1. Refrain from revising the CPT surgical pathology code family for CY 2027.
  2. Ensure that any future review follows the established valuation process, including comprehensive assessment of both the physician time and intensity associated with these services.
  3. Not rely on the MHCC analysis as a substitute for comprehensive clinical and comparative evaluation, particularly given the study’s acknowledged methodological and data limitations.
  4. Preserve the stability of these essential pathology services by adhering to established review pathways and evidence-based processes.
  5. Recognize that unwarranted payment reductions could jeopardize patient access to timely, accurate, and high-quality pathology diagnoses, with significant implications for patient care, treatment decisions, and clinical outcomes.

Federal agencies carefully review public comments during the rulemaking process, particularly those submitted by professionals who understand firsthand how these policies affect research, patient care, and the practice of medicine.

Please submit your comment utilizing the CAP Action Alert by 11:59 pm September 14.

Complete the action alert here.