AMA urges CMS to restore funds to 2026 Medicare conversion factor
In a letter to the Centers for Medicare & Medicaid Services (CMS) deputy administrator and director of the Center for Medicare, the AMA outlined its findings from a review of claims for code G2211 (PDF), an add-on code that physicians can report in addition to an office visit code for Medicare patients with whom they have a longitudinal relationship and whose care is more complex.
In establishing a budget neutrality adjustment for the code, which was introduced in 2024, CMS assumed that G2211 would be reported 38% of the time that an office visit is reported. The AMA analysis found that this budget neutrality adjustment significantly overstated Medicare expenditures for G2211 by $1 billion. Based on actual claims submitted for the code in 2024, the AMA estimates that it was only reported with about 11% of office visit claims that year instead of 38%. To correct this misestimate, the AMA is strongly recommending that CMS apply a prospective positive adjustment to the 2026 Medicare conversion factor to restore the $1 billion annually that is being syphoned from Medicare physician payment rates in error.
