Proposed Medicare fee schedule adds new primary care billing codes for telehealth, preventive care

Publish date: JULY 12, 2013

New Medicare codes to pay for non face-to-face visits for patients could go into effect in 2015. A proposal released by the Centers for Medicare & Medicaid Services (CMS) this week details two G-codes for primary care physicians for wellness and preventative care services and an expansion of telehealth services.

One code would allow primary care physicians to bill Medicare for regular physician development and revision of plan care, communication with other health professionals and medical management over 90-day periods for patients with two or more chronic conditions. Patients would have to qualify through either an annual wellness visit or a preventative physical exam.

Another code would expand billable telehealth services to include designated rural areas near urban areas with a shortage of physicians.

The new proposed codes are proof that Medicare is placing more value on wellness and preventative services provided by primary care physicians, says Rene Quashie, senior counsel in the health and life sciences practice at Epstein Becker & Green, P.C.

“Many policymakers have concluded that (primary care physicians) will play a critical role of changing how healthcare will be delivered in the future in this country—especially as we transition from a fee-for-service environment to one rewarding quality and patient outcomes. This is especially true in the management and treatment of chronic conditions,” Quashie says, adding that expanding telehealth eligibility also shows Medicare’s progression. “This is a response to increasing pressure by providers, patient groups, and other stakeholders to improve access to care in certain rural areas. And teleheath is a great way to bridge access.”

Jeff Cain, MD, president of the American Academy of Family Physicians (AAFP), says the codes would help create a more equitable payment system for primary care physicians. “Such changes demonstrate CMS’ intent to support primary care through policies that promote comprehensive and continuous care,” Cain stated, while also denouncing the Medicare sustainable rate growth (SGR) formula that will reduce the physician payment rate starting January 2014. “In light of the SGR’s mandate that CMS slash Medicare physician payment by 24.4%, these incremental increases do nothing to sustain primary medical care, much less build the primary care physician workforce.”

Cain added that the AAFP is preparing comments on the 2014 Medicare Physician Fee Schedule to submit to CMS by the September 6 deadline. The final schedule is slated to be released by November.

The fee schedule proposal also states changes to be made to the Physician Quality Reporting System, the Medicare Electronic Health Record Incentive program and the Physician Compare tool on the website. CMS is also continuing efforts to phase in the Value Modifier mandated by the Affordable Care Act.

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