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Join AUGS Efforts to Oppose Center for Medicare and Medicaid Services (CMS) Proposal to Reduce Office Visit Reimbursement to Physicians in 2019

As part of its Proposed 2019 Medicare Physician Fee Schedule Rule released on July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) has decided as part of their efforts to reduce documentation requirements for Office Visit Services, also known as E/M codes, to also collapse the payment levels into a single payment amount for Levels 2 – 5 of E/M codes.

Below is a table outlining CMS’ proposed payment rates for 2019 versus 2018:

CPT Code

New Office Visits

CY 2018

Non-Facility Payment Rate

CY 2019 Proposed

Non-Facility Payment Rate

99201

$45

$43

99202

$76

$134

99203

$110

99204

$167

99205

$211

 

 

CPT Code

Est. Office Visits

CY 2018

Non-Facility Payment Rate

CY 2019 Proposed

Non-Facility Payment Rate

99211

$22

$24

99212

$45

$92

99213

$74

99214

$109

99215

$148

 

 

CMS is also proposing to reduce payment by 50 percent for the least expensive procedure or visit that the same physician (or a physician in the same group practice) furnishes on the same day as a separately identifiable E/M visit. This is basically a multi-procedure discount policy for those office visits that you bill today with the -25 modifier.

AUGS is very concerned about this proposal and the AUGS Coding Committee will be leading several activities over the next few months to stop this proposal from being implemented on January 1, 2019. The first set of activities are related to commenting on this proposed rule and those comments are due on September 10, 2018.

The AUGS Coding Committee would very much welcome the participation of all AUGS members in their efforts, including data collection and analytics, comment letters, organizing, etc. If you are interested in joining, please contact Colleen Hughes.

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