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Benchmark of the Week
The new year is delivering a batch of fresh billing opportunities for medical groups, and many practices say they will take advantage of an E/M add-on code and an assessment service capturing patients’ social determinants of health.
Most of the interprofessional consultation services that saw a spike in claims during the initial COVID wave returned to lower utilization, except for a glaring outlier: the most-reported interprofessional consult code 99451 continues its surging growth trajectory.
With a 3.4% conversion factor (CF) cut looming in 2024 and Congress looking less likely by the day to deliver timely relief, providers who routinely bill services from CMS’ “selected codes” chart can at least take comfort that none of the 23 non-facility codes are taking too big a loss.
Primary care management (PCM) services, the care management service for patients with one high-risk and complex, chronic illness, experienced a massive boost the year the codes migrated from the HCPCS to the CPT code set.
The conversion factor may be pulling down fees in 2024, but some codes are bucking the trend. In some instances, CMS decided to recast the relative value units (RVU) tied to non-facility payments, and fees are jumping.
The final specialty-based fee projections look a lot like the ones CMS proposed several months ago. Setting the threshold at positive or negative 2%, a total of 10 specialties are on pace to see fee gains in 2024, while 18 are in the red.
All but one code in the series of six initial (99221-99223) and subsequent (99231-99233) hospital care encounter codes saw a claims drop-off in the three-year period from 2020-2022, and providers saw a decline in total payments over the same span.
Wondering what gets a new physician to join your practice? No surprise, it’s usually about money. However, you may find the factors that come a close second and third, and that convince doctors to stay with a practice, more unexpected.
Emergency medicine providers are the top team players, according to analysis of Medicare data for modifier FS (Split [or shared] evaluation and management visit).
Two years after the pandemic dealt a blow to the health care ecosystem, one key marker of the system’s vitality – routine office visits – had largely not recovered. The most-reported office visits, reflected in codes 99213 and 99214, sat at a depressed rate of -23% and -8%, respectively, in the four-year period from 2019 to 2022.


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