Dear ACC Leaders,

ACC Advocacy staff continue to review and analyze the overarching 2019 Medicare physician fee schedule proposed rule; however, given several questions regarding the impact of the proposal to simplify documentation requirements for evaluation & management (E/M) services, we thought it would be helpful to provide an update in this area.

This effort aims to reduce administrative burden for practices. Documentation requirements currently associated with a Level 2 visit for history, exam, and/or medical decision making would be the minimum documentation standard for all levels of service. That proposal is paired with creation of blended payment rates to new and established office visit E/M services that would apply to levels two through five.

In addition to the blended payment rates for new and established patients, clinicians may bill one or more add-on codes to reflect the added value of primary care services, specialty care services, and/or prolonged face-to-face services.

As an example, a heart failure patient seen by a cardiologist for a Level 4 visit would still be reported as such. In addition, the add-on for specialty care services would be reported. And, if applicable, the prolonged face-to-face service code may also be reported.The example below shows that a typical Level 4 established patient visit would be paid slightly less, unless it met the prolonged services threshold where it would be paid more. These amounts also include modifications that the Centers for Medicare and Medicaid Services (CMS)has incorporated to adjust for practice expense impacts. These changes coordinate with the previously mentioned documentation reductions.

Example 1


99214(Level 4 E/M)

GCG0X(Specialty care add-on)

GPRO1(Prolonged services)







2019 Proposal




$105.62 or $173.03

CMS projects the impacts of the E/M changes to produce a minimal financial impact to cardiology as a whole. CMS' intent is to make the proposal as budget neutral as possible. The College has already requested that the Department of Health and Human Services (HHS) and CMS provide more transparency into its impact analysis, as we are aware of members performing their own analyses resulting in potentially substantial cuts to payment. Advocacy staff will continue to evaluate this proposal to determine if its impact may differ based on factors such as practice setting, patient mix, and subspecialty.

These are significant changes with the potential to streamline workflows for practices, but also to redistribute E/M payments across and within specialties to a considerable degree. Staff will continue to analyze the proposals and collaborate with peer societies, such as the American Medical Association (AMA), that are also evaluating the impacts. It is important to note that these changes are only proposed at this stage, and we have the opportunity to influence whether/how they are finalized through our public comments and through direct communication with policymakers. A final rule will be published detailing what changes will be implemented before the 2019 fee schedule takes effect in January.

Please feel free to share this update with your chapters and section members as appropriate. We will continue to provide additional information through various channels in the coming weeks. If you have completed any analysis of your own or have other insights or observations, please share with ACC Advocacy staff at and encourage others to do the same. It is also appropriate to submit your own comments directly to CMS here by Sept. 10.


The ACC Advocacy Team

New ACC Video Showcases Stories of Leadership in Cardiology

Leaders from across the cardiovascular care team share their paths to leadership in a new ACC video. The video captures stories from a diverse array of ACC members, including ACC President Mary Norine Walsh, MD, FACC, and Vice President C. Michael Valentine, MD, FACC, as well as up-and-coming leaders, including Board of Governors member Laxmi Mehta, MD, FACC; and Travis Batts, MD, FACC, from ACC’s Leadership Academy Cohort II. The stories these leaders share illustrate the importance of seeking opportunities to lead under ACC’s new governance structure, which supports centralized authority and decentralized decision-making, finding mentors and providing mentorship, and maintaining a focus on the College’s mission to transform cardiovascular care and improve heart health. Watch the video here.

New FACC's and AACCs - 2017-2018

Jonathan Anderson Aliota, MD, FACC - Houston
Amir  Azeem, MBBS, FACC - Sugar Land
Salman Jamaluddin Bandeali, MBBS, FACC - Sugar Land
Kamakki  Banks, MPH, FACC - Plano
Kyler William Barkley, MD, FACC - Lubbock
Brian Cody Barnett, MD,PharmD,FACC - Waco
Travis Carlo Batts, MD, FACC - San Antonio
Linh Phuong Bui, MD , FACC - Houston
Michael S. Cahill, MD, FACC - San Antonio
Marek Wojciech Cena, MD, FACC - San Antonio
Justin Jeffrey Elhoff, MD, FACC - Houston
Peter Ryan Ermis, MD, FACC - Houston
Joe  Fahed, MD, FACC - Houston
Phuong-Khanh Jessica Farley, MD, FACC - Decatur
Sheldon Ygnacio Freeberg, MD, FACC - Tyler
Cesar Y. Guerrero-Miranda, MD , FACC - South Lake
Evan Lowell Hardegree, MD, FACC - Belton
Vu Linh Hoang, MD, FACC - Manvel
Swarnalatha  Kanneganti, MD, FACC - McAllen
Subrata  Kar, DO, FACC - El Paso
Tarif Hisham Khair, MD, FACC - El Paso
Houman  Khalili, MD, FACC - Dallas
Ju Hyun Kim, MD, FACC - Houston
Jacqueline Nichols Kircher, MD, FACC - El Paso
Wilson W. Lam, MD, FACC - Houston
Danny Duc Le, DO, FACC - Arlington
Brian  Lima, MD, FACC - Dallas
David Michael Lofthus, MD, FACC - Flower Mound
James Jacob Mancuso, MD, FACC - San Antonio
Sanjay Haresh Maniar, MD , FACC - Houston
Mehran  Massumi, MD, FACC - Houston
Josh Lamar McKay, MD, FACC - Harker Heights
Anjlee Mahesh Mehta, MD, FACC - San Antonio
Peter Philip Monteleone, MD, FACC - Dale
Vijaiganesh  Nagarajan, MBBS, FACC - Sugar Land
Alireza  Nazeri, MD, FACC - Houston
Tom C. Nguyen, MD, FACC - Houston
Daniel Steven Ong, MD, FACC - Richardson
Arun K. Padala, MD, FACC - Ft Worth
Nicolas L. Palaskas, MD, FACC - Houston
Tejas P. Patel, MBBS, FACC - Odessa
Don Minh Pham, MD, FACC - Houston
Praveen Kalipatnam Rao, MD, FACC - Richardson
Sunil  Reddy, MD, FACC - Houston
Levi Andrew Rice, DO,MBA, FACC - Grand Prairie
Robert Louis Rosenthal, MD, FACC - Dallas
Robert Lee Salazar, MD, FACC - Houston
Samar S. Sheth, MD, FACC - Houston
Joseph M. Szczytowski, DO, FACC - Austin
Travis Paul Taylor, MD, FACC - Corpus Christi
Brandie DeAnn Williams, MD, FACC - Stephenville
Srinivas  Yallapragada, MD , FACC - Dallas
Eric Yota Yang, MD, PhD, FACC - Houston