CPT Codes the AAFP Advocates Adding to Boost the Percentage of Physicians Who Qualify for Medicare's Primary Care Incentive Bonus

Code Sets the AAFP Has Asked CMS to Add to the Numerator Used to Qualify Primary Care Physicisn for the 10 Percent Bonus Enacted Under the Patient Protection and Affordable Care Act

Code SetValue Proposition
Code Set: G0402 - Welcome to Medicare physical
G0101 – Pelvic and breast exam
Q0091 – Pap collection
G0328QW – Fecal Occult Blood Test, immunoassay
82270QW – Fecal Occult Blood Test by peroxidase activity, screening
G0103QW – Prostate Specific Antigen Test (PSA), screening
99406-07 – Smoking cessation counseling
Value Proposition: CMS has encouraged physicians to help ensure that Medicare beneficiaries receive the preventive services they need. The inclusion of these services that are commonly rendered by primary care physicians in the numerator for this bonus will help physicians further promote these valuable services and would not be expected to expand the bonus beyond primary care physician practices.
Code Set: G0008 – Administration flu vaccine
G9141- Influenza A (H1N1) administration
90655, 90656, 90657, 90658, 90660 – Influenza Virus Vaccine
G0009 – Administration pneumonia vaccine
90669 – Pneumococcal Conjugate Vaccine 90732 – Pneumococcal Polysaccharide Vaccine
G0010 – Administration hepatitis B vaccine
90740, 90743, 90744, 90746, 90747 – Hepatitis B Vaccine
Value Proposition: CMS has noted that, “Despite Medicare coverage for influenza, pneumococcal, and hepatitis B vaccinations, the use of these benefits is not optimal.” The primary care physician practice is the ideal setting for patients to be advised about and receive these important preventive services. Inclusion of these services in the numerator for the bonus may facilitate expanded access to these services and would not be expected to expand the bonus beyond primary care physician practices.
Code Set: G0179 - Re-certification for Medicare-covered home health
G0180 - Certification for Medicare-covered home health
G0181 - Supervision of home health services
G0182 - Supervision of hospice services
G0372 - Documentation of need for power mobility device
Value Proposition: Primary care provision of these care coordination services helps ensure that the plan of care for home health and hospice patients is up-to-date and that supplies and services ordered are appropriate to the patient’s condition. Because these services are typically referred to the primary care physician, even after hospitalization overseen by other physicians, it would be appropriate to include these services in the numerator.
Code Set: 36415 – Venipuncture
85610 - Prothrombin time
81002 – Urinalysis, dip stick/tablet reagent, non-automated, w/o microscopy
81003QW - Urinalysis, dip stick/tablet reagent, automated, w/o microscopy
82947QW – Glucose, quantitative, blood
83036QW - Glycosylated hemoglobin test
83037QW - Glycosylated hemoglobin test, by home test kit
Value Proposition: Certain laboratory services are common across primary care practices and the Medicare population. Provision of these services in the primary care practice provides for better care management (i.e., immediate action on physician recommendations vs. referral for action). Inclusion of these services in the numerator for the bonus may facilitate continued access and would not be expected to expand the bonus beyond primary care physician practices.
Code Set: 94010 – Spirometry
94060 – Spirometry, pre- and post- bronchodilator admin.
Value Proposition: Spirometry, in addition to clinical examination, improves COPD diagnostic accuracy compared to clinical examination alone and it is a useful diagnostic tool in individuals with symptoms suggestive of possible COPD. The primary benefit of spirometry is to identify individuals who might benefit from pharmacologic treatment in order to improve exacerbations. These include adults with symptomatic, severe to very severe airflow obstruction. AAFP survey data indicates spirometry is provided by 65% of family physician members making addition of this service to the numerator supportive of continued quality care. While this service is also offered by physician other than primary care physicians, it is unlikely that the addition of these codes would expand the bonus beyond primary care.

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