Save Patient Access to Vein Care

Vein Care and the Proposed 2022 Medicare Cuts

Save Patient Access to Vein Care

Friends and Colleagues,

We need your attention to a serious matter that we are all facing. Vein care practices are facing a payment crisis of a 22% reduction of current 2021 Medicare payment across almost all of the superficial and deep venous CPT codes effective January 1, 2022. If this were to occur, we can expect commercial payments to drop, as these typically will mirror Medicare rates in time.

Our AVLS Healthcare Policy Committee has made it clear to me and to Dr. Kathleen Gibson, AVLS President-Elect, that the proposed 2022 Medicare reimbursement cuts will reverberate for years on office-based care if they are enacted as proposed in 2022. Many office-based clinics will not be able to survive these cuts once they spill over to Medicare Advantage and non-Medicare payers.

Along with other partner specialties, AVLS is mobilizing to protect patient access and fair payment, but it will take significant resources to be successful. Your AVLS is executing now on both a regulatory front and a legislative front, but our efforts will require urgent funding that is above and beyond normal member dues. Your contribution will directly fund Federal emergency advocacy efforts to defend fair payment and patient access to care.

Get involved by providing the needed financial resources to allow the AVLS to engage expert support and research to make our case for this advocacy challenge. The Save Patient Access to Vein Care Defense Fund will ensure appropriate vein care payment and your patients' access to care for years to come.

Why should you contribute? As an example, the proposed 2021-2022 CMS reduction in CPT code 36475 (Radiofrequency, 1st vein treated) will be about $302 in the office setting for every claim. To protect your practice and your patients, your AVLS Leadership is urgently asking you to contribute today. Ask yourself if a contribution to the Save Patient Access to Vein Care Defense Fund could be the best investment you ever made.

Thank you for supporting the AVLS,
Dr. Mark Meissner, AVLS President Dr. Kathleen Gibson, AVLS President-Elect

YES, Contribute Now to Protect my Practice and Keep Access to Care

Breaking Down the CMS Proposed 2022 Part B Regulations and Cuts: What You Need to Know

By Dr. Stephen Daugherty, AVLS Healthcare Policy Committee Chair, AVLS Board Director

Office-based vein doctors have experienced decade-long series of payments reductions for superficial vein procedures and we are now facing a new set of unprecedented reductions that will challenge the survival of many outpatient vein care practices.

Medicare & Medicaid Services (CMS) recently proposed deep, 22% payment reductions to office-based vein care codes in the Proposed Physician Fee Schedule (PFS) Rule for CY2022. To be clear, these reductions impact a gamut of services in the office setting- arterial, IVUS, venous stenting, dialysis access, etc. These cuts are being driven primarily by a change in 2022 office-based RVU calculations in Medicare’s methodology that recognizes undervalued clinical labor data for office-based physicians. However, because of the budget-neutral nature of the national Part B pool, the CMS “pay-for” drastically reduces payment for these vein codes because of the proposed change in the way that the clinical labor data is incorporated into the Physician Fee Schedule. Part B resources are then shifted into other domains of medical care. This proposed CMS adjustment represents the additional reduction, on top of the RUC review of supplies and equipment that have taken place over the past decade or so, and the CMS project that went into effect in 2019 to adjust supplies and equipment costs for many items.

2022 Medicare Proposed Part B Fee Schedule Impact Table: Venous & Lymphatic Medicine Typical codes 2021 vs Proposed 2022 Office Payment

Conversion Factor: CMS is proposing a 3.75% decrease to the Conversion Factor, from $34.89 to $33.58. The CF is used to multiply all NF RVU values to determine payment.

The AVLS will comment to CMS and is working with other provider organizations to urge CMS and Congress to retain the 3.75% increase to the conversion factor (CF) contained in the 2021 MPFS through FY 2023, as mandated by the Consolidated Appropriations Act, 2021 (P.L.116-260). The CAA was signed into law on 12/27/20.

Code Abbreviated Code Descriptor 2021 NF Total RVU 2021 Avg. National Payment in NF Proposed 2022 Total NF RVUs Proposed 2022 Avg. National Payment Payment % Change from 2021 vs 2022
36465 NC Foam, Single Truncal Vein 44.29 $1,545 35.87 $1,205 -22.05%
36473 MOCA, 1st Vein 41.31 $1,441 33.34 $1,120 -22.32%
36475 RF, 1st Vein 37.76 $1,318 30.25 $1,016 -22.89%
36478 Laser, 1st Vein 31.74 $1,108 27.78 $933 -15.76%
36482 Chem. Adhesive, 1st Vein 55.63 $1,941 45.18 $1,517 -21.83%

NF = Non-Facilty, or office site of service

View Impact for All Venous Codes

Additionally, because of the expiration of the late 2020 Congressional action that adjusted the Conversion Factor for 2021, payment will be further driven down because of the proposed 2022 Conversion Factor.

Procedural medicine stands opposed to these cuts, and AVLS is advocating for our members to obtain fair reimbursement in 2022 and beyond.

AVLS members who want additional detail about the proposed CMS payment changes may want to listen to the Vodcast that appeared in the Venous Edge online journal.

AVLS Patient Care Access and Fair Reimbursement Plan

By Dean Bender, AVLS Executive Director
Robert White, AVLS Director of Advocacy

Since the release of the CMS proposed Part B rule for 2022, the leadership and staff at AVLS have been hard at work understanding the impact on our field and developing a strategy to provide patient access and fair reimbursement while avoiding expected payment reductions over the next few years should this proposal go into effect. One thing that is very clear is that this is an advocacy challenge that will be fought on multiple fronts and that will require every member of the AVLS to become engaged at one level or another.

As of this communication, there are 3 major efforts underway:

  1. Vein care clinicians are not the only doctors impacted by the proposed 2022 changes. We estimate thousands of providers will be negatively impacted across numerous specialties. As such, we expect impacted office-based doctors to partner together to provide CMS, the Administration, and Legislature with a united approach on how to deal with the proposed CMS reductions in total office-based RVUs.
  2. Our regulatory response is in development. This effort led by the AVLS Health Care Policy standing committee is beginning to develop our comment letter to CMS providing an argument as to why the proposed rule will ultimately impact patient access to affordable quality care in addition to a large number of non-Physician staff having their jobs threatened. The AVLS's position is that the burden to pay for the CMS proposed increases in clinical labor should not be placed on office-based specialists. In support of our arguments, the AVLS will be investing in a series of research endeavors to provide us the appropriate data to support our arguments as to the negative impact of the Proposed Rule.
  3. Developing a legislative response. For the first time in AVLS history, we are faced with a crisis that will likely only be resolved through our Federal legislative process. To rectify this, we will need to develop relationships on Capitol Hill to enact changes to protect access to care for office-based vein care. AVLS staff is currently exploring several options for legislative consultation for short-term and longer-term efforts. Such resources will potentially benefit the efforts of our coalitions but also the specific needs of our membership and field in general.

For the AVLS to make our case, we need to quickly fund the data research to support our arguments and to fund the legislative expertise needed to navigate Capitol Hill.

AVLS Regulatory Response

The first stage of our defense is to provide a direct response on behalf of our membership and the field in general to the Centers for Medicare Services (CMS). Our team is developing the argumentation to support the position that the 2022 Part B Proposed Rule should not be implemented as written because of the significant impact it will make on patient access to office-based specialty vein care. To support this argument, the AVLS is investing in two key pieces of economic research: 

  • An economic research project from Baylor University is currently underway, modeling the impact of the Proposed Rule on CMS expenditures assuming patient care shifts from non-facility-based treatment (currently ~90% of all claims) to facility-based care, assuming that financial impact of 20-22% top-line revenue reductions will result in office closures.
  • Additionally, a well-regarded health care data firm will analyze the financial impact of the Proposed Rule on highly weighted venous medicine practices. CMS estimates a negative impact of 6% for Vascular Surgeons on average and 8% for Interventional Radiologists as the reductions for certain codes are balanced by gains with others. This research will look at venous disease-specific practice impact where the majority of codes are being reduced by 20-22%. 

Our Legislative Response

Because of the severity of the impact of the Proposed Rule, the AVLS also understand the need to approach this fight with Congressional support. As such, the AVLS has partnered with United Specialists for Patient Access (USPA), a professional association of office-based specialty interests dedicated to advocating for access and fair reimbursement for office-based care. USPA is a coalition of office-based specialties fighting to protect the payment structure of the Physician fee schedule. Led by Jason McKitrick and Liberty Partners, USPA is active on Capitol Hill, targeting congressional education. AVLS has taken an Executive membership position with the Coalition, providing a direct voice among the various members, and encourages other large venous-related groups to join the USPA. 

Additionally, we need every member to engage with their local legislators to educate them on the impact of the Proposed Rule and request their support in protecting the future of office-based specialty care. Please join our efforts by: 

What Can I Do?


It is imperative that AVLS develops the financial resources in preparation to act quickly once the CMS Final Rule is released in November. Please give to the Save Patient Access Defense Fund. If we get 300 members to donate their revenue from a single thermal ablation, then we will be able to build a defense fund that is ready to act!

Contribute Now

Thank you to those who have donated! As of September 1, the Save Patient Access Defense Fund has amassed $32,451  in donations from 40 donors. We want to htank our members who have joined our defense by not only reaching out to their networks and representatives, but also by committing their finances to the Defense Fund. We ask you to join these leaders in our Society by donating today. 

Take our short practice survey.

To inform our Policy Committee with some additional information, we are asking office-based members to share their input by completing this short survey. Your responses will be kept confidential.

Take the Survey

Encourage your Legislators to Sign the Rush-Bilirakis Letter

Ask your members of Congress to support a joint House letter being circulated by Members of Congress Bobby Rush (D-Ill.) and Gus Bilirakis (R-FL.) regarding the deep 2022 payment cuts proposed by Medicare (CMS). 

Request your member of Congress support the Rush-Bilirakis Letter

Ask your member of Congress to review the Rush-Bilirakis letter and to fully support and endorse this letter.

Review the Letter

As of September 1, 41 members of Congress have signed on, so if you see your member of Congress below, they are already on board:

  • Rush, Bobby (D)
  • Bilirakis, Gus (R)
  • Bishop, Sanford (D)
  • Brownley, Julia (D)
  • Cardenas, Tony (D)
  • Carter, Earl (D)
  • Case, Ed (D)
  • Cohen, Steve (D)
  • Craig, Angie (D)
  • Cuellar, Henry (D)
  • Davis, Danny (D)
  • Delgado, Antonio (D)
  • Deutsch, Ted (D)
  • Duncan, Jeff (R)
  • Fitzpatrick, Brian (R)
  • Garbarino, Andrew (R)
  • Gonzalez, Tony (R)
  • Jackson-Lee, Shelia (D)
  • Joyce, John (R)
  • Keller, Fred (R)
  • Kuster, Ann (D)
  • Krishnamoorthi, Raja (D)
  • Lamborn, Doug (R)
  • Lee, Barbara (D)
  • Long, Billy (R)
  • McBath, Lucy (D)
  • McKinley, David (R)
  • Morelle, Joseph (D)
  • Murphy, Greg (R)
  • Norton, Eleanor (D)
  • O'Halleran, Tom (D)
  • Payne, Donald (D)
  • Peters, Scott (D)
  • Raskin, Jamie (D)
  • Reschenthaler, Guy (R)
  • Ross, Deborah (D)
  • Stefanik, Elise (R)
  • Stenube, Greg (R)
  • Tonko, Paul (D)
  • Upton, Fred (R)
  • Weber, Randy (R)

Contact your Legislators

Engage with your member of Congress about this topic. Post this issue in all your office reception rooms and encourage your patients to also contact their Congress representatives! Discuss this issue with your patients if the opportunity presents itself. This is a critical patient access issue, and so it is right to discuss especially with your Medicare patients! Attend a district Town Hall to raise your concerns. Best of all, call and request a 20-minute-or-so meeting in the representative’s district office with the member and their staff. Make a random stop by your representative's district office! Get their attention any way you can.

Contact my Senator

Contact my Representative

Attached is suggested text that you can use in your email or request to meet. I recommend customizing your letter to your practice, such as location(s) and the number of staff you employ.

Download Sample Letter

Submit your own Comments on the 2022 Payment Cuts

As a venous clinician and AVLS member, you are an unparalleled source of knowledge and experience in the domain of venous medicine. We encourage you to take 15-20 minutes to submit your own comments to Medicare. Comments are due no later than September 13th. 

The AVLS has prepared a basic template letter on the issue that you can customize in just a few minutes. Please edit this with your personal information, and add any information specific to you and your practice, such as vignettes on the Medicare patients you see. 

Some ideas that might add more impact to your letter include:

  • Your patient population that is rural or underserved - who will care for these patients if offices start to close?
  • How far do patients travel to your office, and how does the ease of office-based care compared to other sites of service?
  • How has COVID-19 already impacted your practice and your ability to serve patients?

Once you edit and finalize your letter, comment electronically by visiting and following the "Submit a Comment" instructions. Use file code CMS-1751-P in commenting, and upload your comment letter.

Download Letter Template

Watch the AVLS Advocacy Webinar Recording

The AVLS Advocacy Committee will host an informational webinar to update our membership about the Proposed 2022 Payment Rule on Thursday, August 26, at 8:00 PM EDT. Registration is free, and the webinar will be restricted to AVLS Members only.

Watch the Recording

In addition to attending the webinar, we strongly encourage AVLS members to keep each other engaged and informed on this urgent matter by contributing to discussions in the MAC.

Join the Conversation

If you have any questions or comments on this subject, please reach out to [email protected] or 510.346.6800.

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