The AMA is fighting to stop the 3.37% pay cut contained in the 2024 Medicare physician payment schedule, but elsewhere in the 2,000-page document the Centers for Medicare & Medicaid Services’ (CMS) followed AMA recommendations on telehealth, diabetes prevention, and for billing of split or shared evaluation-and-management (E/M) visits.
“The final rule includes policies aiming to advance health equity under Medicare Part B; helping patients navigate cancer treatment and treatment for other high-risk conditions,” Gift Tee, director of the CMS Division of Practitioner Services, said at the AMA CPT® and RBRVS Annual Symposium, held virtually this year.
The AMA and nearly 120 state medical associations and national medical specialty societies sent a joint letter (PDF) to congressional leaders urging them to cancel the 3.37% cut and fix Medicare’s systemic problems.
First Lady Jill Biden, EdD, also appeared during the symposium, and she briefly explained some of the new cancer treatment-navigation services approved by CMS and how existing Current Procedural Terminology (CPT®) codes and newly developed CMS Healthcare Common Procedure Coding System (HCPCS) codes will facilitate payment and encourage the use of these services.
“Beginning next year, Medicare will pay for this type of service for patients with cancer and other serious illness,” Biden said in a video. “We also partnered with the AMA to update their coding guidance.”
The First Lady was referring to Principal Care Management CPT codes 99424–99427, which represent services that focus on the medical or psychological needs manifested by a single, complex chronic condition expected to last at least three months and includes establishing, implementing, revising or monitoring a care plan specific to that single disease and are not limited to use with oncology patients.
The AMA released a CPT Assistant Special Edition (PDF) on the appropriate CPT codes for reporting oncology-navigation services. This work is the culmination of more than six months of collaboration with the Biden administration’s Cancer Moonshot initiative.
Biden noted that the four codes “can be used to pay for navigation services today,” and she urged physicians to use them and for commercial insurance companies to pay for these navigation services to help quicken access to treatment.
“Of all the things cancer steals from us, time is the cruelest,” the first lady said.
During a Q&A session, Tee noted that CMS will be posting educational materials on its Medicare Learning Network website regarding the new codes and that CMS is not planning to limit the types of physician specialties that can use the new codes to receive payment for principal illness-navigation services.
Budget-neutrality law cuts payments
In his presentation, Tee noted that, if the payment schedule grows by more than $20 million, CMS is required by law to offset that growth by lowering payments elsewhere. The so-called budget-neutrality adjustment for 2024 is negative 2.18%.
He explained that about 90% of the overall budget-neutrality adjustment is attributable to the proposal to implement a separate add-on payment for the CMS HCPCS code G2211, known as the inherent complexity add-on code.
The overall 2024 payment schedule conversion factor is $32.74, a 3.39% cut from 2023’s factor of $33.89. The AMA supports draft legislation that was introduced in Congress to reform budget-neutrality formulas applied to the physician payment schedule.
Leading the charge to reform Medicare pay is the first pillar of the AMA Recovery Plan for America’s Physicians.
The AMA has challenged Congress to work on systemic reforms and make Medicare work better for you and your patients. Our work will continue, fighting tirelessly against future cuts—and against all barriers to patient care.
Through the AMA’s Fix Medicare Now website, physicians and patients can easily connect with their Congressional representatives and urge them to support H.R. 2474, the Strengthening Medicare for Patients and Providers Act. The bipartisan bill would give physicians an annual, permanent inflationary payment update in Medicare tied to the Medicare Economic Index.
G221 code explained
Tee noted in the Q&A session that CMS will be providing educational materials on HCPCS G2211code with clinical examples.
“What we’re trying to describe are the activities and/or continued responsibility that the practitioner is taking on by serving as the focal point for the health care services being furnished to the patient when that patient presents with different complex illnesses,” Tee said.
In his presentation, Tee noted that the code acknowledges the work involved in building a trusting patient-physician relationship and the “primary and longitudinal care that has been previously unrecognized and unaccounted for during evaluation and management visits.”
The new schedule also includes payments for dental or oral examination and treatment to address complications after radiation, chemotherapy, or surgery used in the treatment of head and neck cancer.
Regarding telehealth, the 2024 payment schedule:
- Allows teaching physicians in all training settings to be present using audio/video real-time communications technology when a resident is providing Medicare telehealth services.
- Removes frequency limitations for critical care consultations.
- Extends public health-emergency flexibilities to allow physicians furnishing telehealth services from their homesto report their office address on Medicare enrollment forms.
The last provision was in response to privacy and safety concerns about including physician home addresses as practice locations on their enrollment forms.
Social drivers’ impact recognized
Tee noted that CMS finalized coding and payment for social determinants of health risk assessments recognizing when physicians spend time and resources assessing outside factors impacting the patient, that affect their ability to treat a patient.
Also finalized were codes and payment for social determinants of health risk assessments furnished with an E/M or behavioral health visit.
Other services finalized include payments when physicians or staff train caregivers to support patients with certain diseases or illnesses such as dementia in carrying out a treatment plan.
“Medicare will pay for these services when furnished by a physician or a non-physician practitioner, or therapist as part of the patient’s individualized treatment plan or therapy plan of care,” Tee said.
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