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New Primary Care Codes for Telehealth, Preventive Care


Physicians get a lot of phone calls, which - the business savvy physician might point out - they don't usually get paid for. However, a new Medicare code could now pay for that.

Physicians get a lot of phone calls, which — the business savvy physician might point out — they don’t usually get paid for. However, a new Medicare code could now pay for that.

Currently, Medicare will pay for primary care management services if they are a part of a face-to-face visit. The Centers of Medicare and Medicaid (CMS) has proposed to pay for specific non face-to-face visits, particularly for complex chronic care management services. These services would include communicating with other treating health professionals and medication management.

Medicare would pay “through two G-codes for establishing of a plan of care and furnishing care management over 90-day periods,” according to the CMS proposal.

One of these codes expands billable telehealth services, now including certain rural areas near urban areas that have a shortage of physicians.

The new fee schedule also adjusts misvalued codes, which would raise payment rates for evaluation and management services by as much as 3%, according to the American Academy of Family Physicians (AAFP)

"Such changes demonstrate CMS' intent to support primary care through policies that promote comprehensive and continuous care," Jeff Cain, MD, president of AAFP, said in a statement.

Unfortunately, there will be no change on the sustainable growth rate. The most recent estimate from CMS was that the physician fee schedule update would be a 24.4% reduction, which more than negates the small payment increases from code adjustments and new codes, Cain points out.

"If Congress fails to avert this disastrous pay cut before 2014, family physicians once again will be forced to choose between caring for Medicare beneficiaries at a significant financial loss or ending their participation in Medicare," Cain said.

According to an analysis by AAFP, the pending SGR reduction would mean that the average family physician could lose $89,763 in revenues in 2014.

"No small business can sustain itself in the face of such drastic revenue reductions," Cain said.

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