2024 MPFS Final Rule: If you don’t have time to read the final medical fee schedule rule, be sure to read this section.
Medicare policies may have a significant impact on all payer policies. Therefore, it is important for anyone working with health insurance claims to be aware of policy changes in the New Year. We can do this by reading the annual MPFS final rule of the Medicare Physician Fee Schedule (MPFS).
2024 MPFS Final Rule Highlights: E/M Visit Updates, Complex Surcharge, and Extended Vaccination Payments
Unfortunately, the document is very long and doesn’t feel like a fast-paced novel. To save you some time, here are the highlights of the 2024 MPFS Final Rule as it relates to medical billing and coding. Assessment and Management (E/M) Visit
HCPCS Level II + G2211 Complex E/M Visit Surcharge due January 1, 2024. This additional code may be reported in conjunction with E/M Visits M in Office/Outpatient Visits, to “account for additional resources” related to primary care or similar ongoing medical care related to the patient’s unique, serious or complex situation. State,” explain the Centers for Medicare and Medicaid Services (CMS) in the final report.
Vaccinations During the COVID-19 public health emergency, Medicare paid providers an additional $35.50 to administer COVID-19 vaccines to Medicare beneficiaries at their place of residence. CMS has extended this additional payment for at-home COVID-19 vaccinations and pneumococcal, influenza, and hepatitis B vaccines through 2024, updated based on the calendar year 2024 MEI percentage increase ($38).55). The co-payment is per visit, not per vaccination.
Split (or shared) exams
Split (or Shared) policies apply to E/M examinations performed by physicians and non-physician professionals in the same practice group at a facility. CMS has finalized its decision to align with the 2024 CPT® definition for “massive proportion” of more than half of the total time, but has not made the change this year. For Medicare claims in 2024, the physician is the medical billing provider.
Providing a significant portion of medical decision-making or consuming more than half of the total visit time.
The social determinants of health
CMS has completed the permanent addition of HCPCS Level II code G0136. The Medicare Telehealth service begins on January 1, 2024 with the administration of a standardized, evidence-based health risk assessment tool lasting approximately 5 to 15 minutes. This service may be offered as an optional addition to an annual wellness visit. Co-payments and no cost sharing are charged to patients.CMS has also completed separate coding and billing for Community Health Integration (CHI) services (HCCPS Level II codes). G0019 and G0022) and Primary Disease Navigator Services (HCPS Level II codes G0023, G0024, G0140, G0146).
CMS finalized the definition of “nurse” and recommended relative work value units and direct provider spending categories for nurse training services (CTS), reported using CPT® codes 97550-97552, indicating “sometimes therapeutic.” ” These services are optional and must be agreed upon by the patient.