For the fifth consecutive year, physicians face a Medicare payment cut, this time at 2.83% in 2025. This comes after Congress failed to intervene. Additionally, the expanded telehealth access granted during the COVID-19 pandemic is set to expire in March unless Congress takes action.
CMS Support for Primary Care and Vaccination
Despite these challenges, the Centers for Medicare & Medicaid Services (CMS) is taking steps to support primary care and vaccination.
- Telehealth Flexibilities: CMS is working to preserve some telehealth flexibilities. This includes expanding the list of telehealth services, continuing to suspend frequency limitations for certain visits, and allowing audio-only communication for telehealth services in certain situations.
- Primary Care Add-on Code: CMS has finalized a new add-on code (G2211) for outpatient evaluation and management services provided on the same day as preventive services like annual wellness visits or vaccinations. This recognizes the importance of primary care and aims to improve healthcare outcomes.
- Comprehensive Primary Care Plus: This program supports advanced primary care practices by providing resources for team-based care and predictable payment.
Immunization Coding Updates
The 'Vaccine Coding Caucus' has been renamed the 'Immunization Coding Caucus' to encompass all immunization methods. This group facilitates the rapid release of immunization codes for urgent public health needs. For example, new codes have been added for an mRNA quadrivalent influenza vaccine (90637 and 90638), while codes for discontinued influenza vaccines (90654 and 90630) have been deleted.
Key Takeaways
- Physicians are facing ongoing challenges with Medicare payment cuts.
- CMS is taking steps to support primary care and vaccination through coding changes and telehealth flexibilities.
- Advocacy efforts are crucial to ensure continued support for telehealth and fair physician reimbursement.
Call to Action
The American Medical Association (AMA) is actively advocating for physicians on these important issues. Visit AMA Advocacy in Action to learn more about supporting telehealth and other advocacy priorities.
Source: American Medical Association (AMA) | January 7, 2024