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Monday Feb 25, 2019

The accurate valuation of office visits: one thing you can do

The CPT guidelines and descriptors to report office-visit codes will undergo extensive revision for implementation in 2021(www.ama-assn.org). As a result, the relative value of these visits is being reviewed.

What you can do

On Feb. 25, the AAFP and other organizations sent an email to their members launching a survey asking practicing physicians to estimate their time, work, and direct practice expenses for office-visit codes 99202-99205 and 99211-99215 as well as a new prolonged services code. The link to the survey can be accessed only via that email.

The organizations will present the survey results to the Relative Value Scale Update Committee (RUC) in April. The RUC, in turn, will make recommendations to the Centers for Medicare & Medicaid Services (CMS).

How a code gets its value

CMS assigns relative value units (RVUs) to all services paid under the Medicare physician fee schedule based on three factors: physician work, practice expense, and malpractice expense. A service’s RVUs are then multiplied by a conversion factor (the dollar amount CMS pays per RVU) to determine the Medicare allowed amount.

The RUC is made up of 31 members from the American Medical Association, national medical specialty societies, and other organizations who regularly review medical services to determine whether they are valued appropriately and make recommendations to CMS on the resources required to provide medical services. CMS makes all final decisions about what the RVUs and payments should be for services under the Medicare program.

Posted at 09:00AM Feb 25, 2019 by FPM Editors

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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