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CPT Codes the AAFP Advocates Adding to Boost the Percentage of Physicians Who Qualify for Medicare's Primary Care Incentive Bonus
| Code Set | Value proposition |
| 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 |
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. |
| 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 |
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. |
| 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 |
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. |
| 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 |
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. |
| 94010 – Spirometry
94060 – Spirometry, pre- and post- bronchodilator admin. |
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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