Advocacy Update Jan. 7, 2025
IN THIS ISSUE / Jan. 7, 2025
Medicare Physician Payment
Medicare physician payment cuts effective Jan. 1
Since Congress failed to stop the Medicare physician payment cut by Dec. 31, 2024, the 2.8% cut finalized in the Medicare Physician Fee Schedule (PFS) Final Rule took effect on Jan 1. 2025.
Historically, when Congress did not act to avert cuts by Jan. 1, CMS instructed Medicare Administrative Contractors (MACs) to hold claims for a specified period, allowing Congress to act. However, CMS has not issued guidance to date. Dermatologists should submit claims as they normally would under their regular billing practices, and MACs will process claims consistent with CMS’s instructions. The Academy is closely monitoring this situation and will continue to update the membership when more information is available. Members are encouraged to check aad.org and their MAC’s website regularly for the latest updates.
Take Action: Urge Congress to act now to stop the 2.8% cut to Medicare physician payment that took effect on Jan. 1, and provide for an overdue positive inflationary adjustment for physician practices.
Payer Advocacy
Advocacy Win: Aetna fixes Mohs surgery claim edits
As a direct result of AADA’s advocacy, Aetna changed its edits for modifier 59 (PDF) when reported with Mohs surgery. Effective Jan. 1, 2025, additional reimbursement may be provided when reporting evidence of a separate lesion for pathology CPT codes 88300–88309 and CPT codes 88331–88334 when billed on the same date of service as Mohs micrographic surgery CPT codes 17311–17315 using modifier 59.
Payer Advocacy
AADA advocated for clarification on Aetna denied claims for complex repairs
As a result of AADA’s continued commitment to alleviate administrative burdens for dermatologists and maintain appropriate reimbursement for furnished services, Aetna provided clarity on denied claims for complex repairs.
Specifically, dermatologists reported initial denial of complex repair claims reporting place of service (POS) 11. Dermatology practices reported to the AADA that the claim is initially denied but did not specify required information. The AADA learned that Aetna needs clear documentation describing the extent and dimension of undermining performed and the depth and the measurements and dimensions of the undermining in relation to the dimensions of the surgical defect.
For instance, to report complex linear closure or complex repair, the documentation for the operative note should clearly define:
The postoperative defect size
The surgical indication(s) requiring use of complex layered closure, including:
The need for extensive undermining must be documented as undermining that extends greater than, or equal to, the maximum width of the surgical defect as measured perpendicular to the closure line along at least one full edge of the defect
Presence of exposed bone, cartilage, tendon, or named neurovascular structure
Involvement of free margins of the helical rim, vermillion border, or nostril rim
Placement of retention sutures
Aetna confirmed that it will not ask for records if this information is submitted with the claim. Dermatologists may contact Aetna with any questions or for additional details related to their claim.
Skin Cancer Prevention
AADA presses FDA on sunscreen access
The AADA urged the FDA to provide updates on its ongoing review to ensure safe and effective access to sunscreens. The AADA submitted a comment letter (PDF) related to the reauthorization of the over-the-counter (OTC) Monograph Drug User Fee Drug Program (OMUFA) for fiscal years 2026 through 2030. In the letter the AADA urged the FDA to ensure access to safe and effective sunscreens by prioritizing timely updates to the OTC sunscreen monograph and expediting the approval of new ingredients that meet safety standards, while collaborating with stakeholders to support these efforts.
AADA News
Save the date — SkinPAC reception at Orlando Annual Meeting
SkinPAC will host two events to thank our 2025 donors at the Annual Meeting in Orlando this March.
The SkinPAC Donor Reception will take place on March 6 from 6:30 p.m. – 8 p.m. at the pool deck of the Hyatt Regency Orlando (9801 International Drive) and is open to all 2025 SkinPAC members who contribute $250+, and residents who contribute $25+. Please RSVP to skinpac@aad.org.
SkinPAC will also host the annual SkinPAC Donor Lounge, open to all 2025 members at the Silver ($1,000) level and above ($100 for residents).
The lounge will be in Room W102AB at the Orlando Convention Center and will serve as a fun place to relax and connect with colleagues during the Annual Meeting, as well as enjoy breakfast, lunch, and snacks and will be open during exhibit hall hours on March 7 and 8 from 8 a.m. – 5 p.m. and on March 9 from 12 p.m. – 3 p.m.
AADA News
Join your colleagues and contribute to SkinPAC
Thanks to your contributions, SkinPAC had another record-breaking year in 2024, raising $1,111,213 from 1,063 contributors.
Help us start the new year and new election cycle strong by contributing to SkinPAC. Your contributions strengthen our relationships on Capitol Hill and reinforce our grassroots and lobbying efforts, including resources we need to ramp up our fight to reform Medicare physician payment in the new Congress.
Contribute online at www.skinpac.org or by texting SkinPAC to 71777. Email skinpac@aad.org with any questions.
The political purpose of the American Academy of Dermatology Association Political Action Committee ("SkinPAC") is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for elective office, and other federal political committees, who demonstrate understanding and interest in the view and goals of the American Academy of Dermatology Association.
Contributions to SkinPAC are not deductible for federal income tax purposes. Contributions to SkinPAC must be made from your funds and may not be reimbursed. SkinPAC cannot accept contributions from corporate accounts. Any recommended contribution amount is merely a suggestion. All AADA members have the right to contribute more or less or refuse to contribute without reprisal. Federal law prohibits us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and name of the employer whose contributions exceed $200 in a calendar year.
