12 physician societies back bill to fix Medicare office-based pay gap

A coalition of 12 physician specialty societies has announced support for the Promoting Fairness for Medicare Providers Act (H.R. 7863), bipartisan legislation that would create a new payment category for office-based procedural care under Medicare.

The bill, introduced by Representatives Gus Bilirakis (R-FL), Raul Ruiz (D-CA), Greg Murphy (R-NC), and Danny K. Davis (D-IL), would establish an "Office-Based Facility" payment category for surgical procedures with supply costs over $500, paying at 90% of ambulatory surgery center rates. It would also remove high-cost supplies from the Physician Fee Schedule practice expense methodology, which the coalition said relies on flawed survey data from 2008 and reduces actual practice expense costs by up to 58% before reimbursement is calculated.

Supporting societies include the Society of Interventional Radiology (SIR) and the American College of Radiation Oncology (ACRO), among others. The coalition said office-based reimbursement for affected procedures has fallen 22% since 2019, while hospital outpatient rates for the same services rose 22% over the same period, accelerating consolidation of independent practices into hospital systems.