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Invited Commentary
May 2016

Understanding Responses to Reductions in CMS Payments

Author Affiliations
  • 1Project HOPE, Bethesda, Maryland
JAMA Intern Med. 2016;176(5):699-700. doi:10.1001/jamainternmed.2016.0216

In this issue of JAMA Internal Medicine, Callaghan et al1 report their analysis of service use and payments following a substantial reduction in the payment by the Centers for Medicare & Medicaid Services (CMS) to physicians through Medicare as reimbursement for nerve conduction studies (NCS) as of January 2013. Payment for electromyography, which is typically performed together with NCS, was not changed. The CMS changed the payment as a result of a directive that was part of the 2010 Affordable Care Act to reduce amounts paid by Medicare for “overvalued” services. Electromyography was identified as a service that had exhibited rapid volume growth as the result of having been submitted multiple times in the same practice or for the same reason for reimbursement, or having been submitted in conjunction with other codes, which was the case for NCS. The payment change was also consistent with (but greater than) a recommendation from the Relative Value Scale Update Committee, which brings together the American Medical Association and medical specialty societies to offer recommendations to the CMS for physician service reimbursement.2

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