LUGPA submits comments on MPFS and OPPS Proposed Rules and Surprise Billing Interim Final Rule

Sept. 21, 2021

LUGPA has submitted comments on the CMS proposed rules addressing changes to the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (HOPPS) for 2022, as well as the Requirements Related to Surprise Billing Interim Final Rule.



LUGPA’s comments focused on expressing concerns regarding the reduction in the conversion factor for 2022, opposition of proposed updates to non-physician clinical labor RVUs, and support of CMS’ proposed site-neutrality payment policy for E/M codes.

  • LUGPA urges CMS to exercise its regulatory authority to mitigate the impact of the reduced conversion factor. While the conversion factor is determined by statute and not rulemaking, LUGPA requests that CMS consider all possible options to mitigate the negative impact of the reduction on providers.
  • LUGPA urges CMS not to finalize its proposal to update the non-physician clinical labor costs used in the calculation of practice expense relative value units for 2022. LUGPA provided empirical support that the update would have an adverse impact on providers performing supply and equipment intensive procedures in non-facility settings and would drive these procedures to higher cost sites of service.
  • LUGPA Supports the transition from MIPS to MVPs, however, we are concerned with the lack of opportunities for urology as a specialty to participate and would welcome the opportunity.
  • LUGPA supports CMS’ proposal to include end-stage renal disease facility affiliation reporting on the compare tools. LUGPA supports transparency in physician relationships and commends CMS for the initiative in expanding reporting requirements to include hospitals.
  • LUGPA supports CMS’ proposal to revise and clarify regulation on indirect compensation arrangements


LUGPA supports the proposals in the OPPS and ASC Proposed Rule concerning 340B payment policy and opposes CMS’ proposed reinstatement of the inpatient only list. LUGPA recommends that CMS:

  • Maintain site neutrality as a primary guiding principle in setting OPPS/ASC payment policy and should continue to promote site neutral payment under the OPPS/ASC PPS
  • Proceed with the previous administration’s finalized initiative to eliminate the inpatient only list and expand the ASC covered procedure list.
  • Finalize its proposal to increase the civil monetary penalty amounts for hospitals that are not in compliance with transparency requirements
  • Continue to apply the productivity-adjusted hospital market basket update to the ASC PPS.

Furthermore, while CMS has not proposed to address payment discrepancies for ESWL, LUGPA urges CMS to ensure adequate reimbursement for ESWL in the ASC setting by amending its device-intensive procedure payment policy.

In its commentary on the Surprise Billing Interim Final Rule, LUGPA endorses the principle of surprise billing reform that patients should not face financial hardship based on site of service in a health situation, however, we raise concerns with aspects of the IFR that are vague in critical areas. LUGPA recommended that surprise billing requirements be extended to urgent care centers so that the surprise billing requirements apply to both emergency and non-emergency services performed at these sites.

LUGPA’s comment letters on the MPFS and HOPPS proposed rules and the Surprise Billing Interim Final Rule can be found on the LUGPA website.