7 New Codes for Primary Care to Add Serious Revenue

Bob Doherty is senior vice president, governmental affairs and public policy, American College of Physicians and blogs at the ACP Advocate Blog.  I first saw this blog at KevinMD.com and you can read it in it’s entirety by clicking here:

What are the new codes?  Medicare’s wellness examination, which in 2016 will pay $172.69 for an initial visit, and $116.80 for a subsequent one. Transitions of care management, 14 day discharge, pays $164.81;  7 day discharge pays $232.52.  Chronic care management,  20 minutes, pays $40.84.  And, brand new, for the first time starting on January 1, Medicare will pay $85.99 for 30 minutes of advance care planning!  (These payment amounts are before application of Medicare’s geographic adjustments, and apply to services provided in a non-facility setting).

ACP’s regulatory affairs department has prepared a nice spreadsheet that shows the available payments for these services in both the non-facility and facility settings.

Yet many primary care physicians are not routinely billing for these codes, leaving tens of thousands of dollars at the door.  Many say that the documentation requirements are too much, or they might have to hire more staff, so it’s not worth the effort. There is no question that Medicare could make it easier and simpler for physicians to document these services, as ACP has recommended.

At the same time, though, I expect a cost-benefit analysis would show that many primary care physicians and their practices would come out way ahead if they began to bill for these codes, while improving patient care in the process — a real win-win.

So how about it, primary care doctors?  Isn’t it time for you to consider taking advantage of the new codes and revenue opportunities available to you, even as ACP and others continue to advocate for more fundamental reforms to improve payment for primary care?