ACAAI and AAAAI leaders discuss increased costs, proposed cuts, E&M proposal

August 30, 2018

The College and Academy leadership met with the Centers for Medicare and Medicaid Services (CMS) during the week of August 27, 2018, to express our serious concerns about the proposed 2019 reductions in Medicare reimbursement for allergy services. The primary issues discussed were:

  • The failure of reimbursement to keep up with the spike in the cost of venom antigens.
  • The CMS proposal to reduce reimbursement for inhalant allergen immunotherapy.  

We explained that allergists are losing money on venom immunotherapy because the cost of the venom alone exceeds the reimbursement. We told CMS we would be providing evidence, in the form of invoices received from members, of the spike in prices and CMS indicated willingness to consider an increase in reimbursement for 2019.  

We also discussed increases in the cost of inhalant allergens and our disagreement with the price study by CMS contractors which resulted in a proposal to reduce payment. We alerted CMS to the impending increased costs of complying with revisions to USP sterile compounding standards scheduled to take effect in 2020.

We discussed changes CMS made to allergy/immunology indirect practice expense – a consequence of the agency's E/M proposals and urged CMS to delay its proposals and work with the physician community on alternative options. A final rule will be released in early November to take effect January 1, 2019. We will analyze it as soon as it is released and let you know the results.

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