Despite annual threats to Medicare’s physician payment rate, primary care physicians will benefit from the implementation of a new code for visit complexity, among other key changes.
Editor's note: This article was updated 1/23/24 with additional information about codes G0136 and 99459. It was also updated 3/13/24 after Congress and President Biden reversed most of the scheduled Medicare pay cut.
Every year family physicians and their staffs are given the challenge of managing changes in coding and Medicare payment policy. While some years it may be easy to tell whether the changes as a whole benefit your practice financially, this year it’s complicated. Some policies will cut payments and others should boost revenue for family physicians.
It’s a complex picture, but this summary should give you an idea of what to expect for your practice in 2024.
KEY POINTS
- A Medicare rate cut will hurt most physicians financially in 2024 unless Congress reverses it. But primary care doctors should have it at least partially offset by a new add-on code for visit complexity.
- CPT made several changes to time-based evaluation and management coding to better align it with Medicare guidelines.
- There are few substantive changes to Medicare’s Quality Payment Program in the new year, but there are still some steps practices can take to maximize the benefits of participation.
MEDICARE PAYMENT POLICY CHANGES
First, the bad news. At press time, the Centers for Medicare & Medicaid Services (CMS) had decreased the conversion factor — the amount Medicare pays per relative value unit (RVU) — from $33.89 in 2023 to $32.74 in 2024, barring a reversal by Congress at the 11th hour. (Editor's note: Congress and President Biden reversed most of this cut in March 2024.)
This 3.37% cut is due to partially expiring conversion factor relief and mandated budget neutrality adjustments. Any time Medicare physician payments are estimated to increase by $20 million or more (due to either coverage for new services or rate increases for services already covered), CMS is required to offset that with cuts.
In recent years, Congress has delayed those cuts with COVID-19 relief bills. Although the official COVID public health emergency ended in May, more than 100 medical groups, including the AAFP, urged lawmakers to delay the cuts again, noting that high inflation is increasing the cost of running a practice.1
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