CMS Proposed Payment Changes for Office Visits
Proposed Evaluation and Management (E/M) documentation and payment • CMS proposes to collapse payment for office and outpatient visits. Under the proposal, payment for new patient office visits levels 2 through 5 (99202-99205) would be blended into a single $135 payment. Payment for established patient office visits level 2 through 5 (99212-99215) would be blended into a single $93 payment. o New codes would be created to provide add-on payments to office visits for specific specialties ($9) and primary care physicians ($5). o Documentation for history and exam will focus on interval history since last visit. Physicians will be allowed to review and verify certain information in the medical record entered by ancillary staff or the beneficiary, rather than re-entering the information. To replace existing documentation guidelines, CMS proposes to allow use of: 1995 or 1997 documentation guidelines, Medical decision-making, or Time. • When physicians report an E/M service and a procedure on the same date, CMS proposes to implement a 50% multiple procedure payment reduction to the lower paid of the two services. • CMS will implement new CPT codes and payment for remote monitoring and inter-professional consultations. o Medicare would pay physicians for their time when they reach out to beneficiaries via telephone or other telecommunications devices to decide whether an office visit or other service is needed. CMS also proposes to pay for the time it takes physicians to review a video or image sent by a patient seeking care or diagnosis for an ailment.