Important Updates on CMS PFS Final Rule 2024

Dec. 2023

Avoid last-minute surprises – prepare for upcoming changes now. Here's a comprehensive overview of key updates in the CMS PFS Final Rule for 2024:

1. Reduction of 2024 Conversion Factor (3.37% projected):
• Note: Congress might intervene to delay or reduce this reduction.
2. Introduction of HCPCS Code G2211:
• CMS announces a major coding update for 2024.
• Effective January 1, 2024, a separate add-on payment for HCPCS code G2211 will recognize resource costs associated with specific E/M visits.
• Refer to CMS guidance for details and cross-reference with previous documents.
• New Resources on 2024 Medicare Physician Fee Schedule Changes
3. Telehealth Flexibilities Extended:
• CMS maintains telehealth flexibilities until the end of 2024.
• Highlights include:
• No originating site restrictions.
• Coverage of audio-only services on the Telehealth Services List (from Dec. 29, 2022).
• Payment for telephone E/M services (codes 99441-99443).
4. Advancing Health Equity:
• CMS finalizes coding and payment policies to promote health equity.
• Policies cover payment for caregiving services, community health integration, principal illness navigation, and social determinants of health risk assessments.
5. No Increase in MIPS Performance Threshold:
• The MIPS performance threshold remains at 75 points for the 2024 performance period.

HCPCS Code G2211 Overview:

• HCPCS code G2211, known as the 'cognitive code,' is an add-on code for E/M visits.
• Designed to recognize resource costs for ongoing care related to a patient's single, serious, or complex condition.
• Notable for urology and primary care providers.
• Limitations: Cannot be reported with modifier 25 on the same day and not applicable to all urology visits.

Expected Frequency of Use:

• CMS expects G2211 to be initially billed with 38% of E/M services, increasing to 54% when fully adopted.

Summary:

HCPCS code G2211 signifies a significant shift, emphasizing CMS's commitment to consistent patient care. While it improves resource cost recognition, be aware of specific criteria and potential budget neutrality implications. Consult official CMS documentation healthcare authorities and utilize additional resources for in-depth information.

Action Steps:

• Refer to CMS documentation and relevant healthcare authorities.
• Stay informed and collaborate with your institution's billing department.
• Assess individual circumstances or practice applicability based on specific guidelines.

Thank you for your attention. Your commitment to quality patient care is appreciated.

Additional Resources:

1. CMS Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule
2. AAPC Information on G2211
3. CMS Code Sets Overview
4. LUGPA’s New Medicare Physician Fee Schedule Calculator Tool
5. LUGPA Fact Sheet: HCPCS Code G2211