2024 Medicare Physician Fee Schedule Final Rule brings good (and bad) news
When CMS published its calendar year 2024 Physician Fee Schedule Final Rule, it created quite an uproar. Why? In it, the agency finalized a 3.4% payment cut, spurring frustration among many, including the American Medical Association (AMA) that continues to advocate for Medicare reform. According to the AMA, Medicare payments are deep, relentless, and do not keep up with inflation. In fact, when adjusted for inflation in medical practice costs, the AMA found that Medicare physician payment declined 26% from 2001 to 2023.
However, the good news is that the 2024 physician fee schedule rule does include several revenue opportunities that incentivize physicians to focus on patient engagement and address unmet health-related social needs. In this article, we’ll provide an overview of those opportunities and explain how to bill for them.
Caregiver training services
Caregiver training is a newly billable service during which physicians or other qualified health professionals provide caregivers with strategies and techniques to facilitate a patient’s functional performance in the home or community. This includes activities of daily living, transfers, mobility, communication, swallowing, feeding, problem solving, and safety practices.
CMS defines a caregiver as an adult family member or other individual who has a significant relationship with the patient and who provides a broad range of assistance to an individual with a chronic or other health condition, disability, or functional limitation. It also includes a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition. Caregiver training services are reasonable and necessary when treating practitioner determines the patient could not carry out a treatment plan without the help of a caregiver.
How do you bill for it? Report CPT code 97550 for the first 30 minutes of face-to-face caregiver training with an individual (singular) caregiver without the patient present. For the first 30 minutes of group caregiver training, report CPT code 97552. For each additional 15 minutes, report CPT code 97551. Be sure to refer to the physician fee schedule final rule for more information about medical coding and medical billing for these services.
Community health integration services
Community health integration is a newly billable service during which a certified or trained auxiliary professional (i.e., medical practice community health worker), spend 60 minutes per calendar month addressing social determinants of health (SDOH). These services, provided under the direction of a physician or other practitioner, include person-centered assessments, patient-driven goal setting, care coordination, communication with community-based service providers, health education, self-advocacy skills, health system navigation, social and emotional support, mentorship, and much more.
How do you bill for it? Report HCPCS code G0019 for the first 60 minutes per calendar month and G0022 for each additional 30 minutes per calendar month. The physician fee schedule provides additional information about these codes and how to report them to ensure revenue integrity.
SDOH risk assessments
This newly billable service is for time spent (5-15 minutes) administering a standardized, evidence based SDOH assessment tool. Medicare doesn’t require a specific tool, but it does give these examples of evidence-based tools for consideration: CMS Accountable Health Communities tool, the Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE) tool, and instruments identified for Medicare Advantage Special Needs Population Health Risk Assessment.
How do you bill for it? Report HCPCS code G0136. Medical practices can report this code in addition to codes for an Annual Wellness Visit, E/M office visit, behavioral health visit, hospital discharge visit, and visits in other outpatient settings. Note that Medicare has permanently added this service to its Telehealth List starting January 1, 2024.
Principal illness navigation services
This is a newly billable service that includes many of the same elements as community health integration. However, the main difference is that principal illness navigation is provided by patient navigators and certified peer specialists (not community health workers) under the direction of physician supervision.
How do you bill for it? When patient navigators provide principal illness navigation, report HCPCS code G0023. This code is for the first 60 minutes of principal illness navigation services per month. Report HCPCS code G0024 for each additional 30 minutes per calendar month. When certified peer specialists perform principal illness navigation, report HCPCS code G0140. This code is for the first 60 minutes of principal illness navigation services per month. Report HCPCS code G0146 for each additional 30 minutes per calendar month.
Evaluation and management (E/M) add-on services
This is an add-on service for care that serves as the continuing focal point for all needed healthcare services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. The service is intended to help physicians capture the additional time, intensity, and practice expenses inherent to longitudinal care.
How do you bill for it? Report HCPCS code G2211 with an office visit E/M code (with the exception of E/M codes reported with modifier -25). Refer to the physician fee schedule final rule for more medical coding and medical billing information to ensure revenue integrity.
Conclusion
Although the 2024 Medicare Physician Fee Schedule Final Rule does include a significant payment cut, it also provides opportunities to generate new revenue and increase medical practice profitability. Medical practices that seize these opportunities can position themselves for financial success in 2024 and beyond. Learn how edgeMED can be part of that strategy to improve financial performance and promote revenue integrity. And be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
