The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule discussed potential add-on codes to represent Evaluation and Management complexity, it has been delayed until 2021. The proposed add-on code was a way to add reimbursement in the new territory of blended E&M payments.
The proposed add-on code for specialists is temporarily called GCG0X. The code would represent additional costs for resources in specialties that have E&M visits as a big percentage of the allowed charges. These specialties typically report level 4 and 5 visits. They often use E&M codes rather than separate codes for the treatments provided to the patient.
The proposed specialties for the add-on code include Endocrinology, Rheumatology, Hematology/Oncology, Urology, Neurology, OB/GYN, Allergy/Immunology, Otolaryngology, or Interventional Pain Management-Centered Care. The add-on code would be listed separately in addition to the E&M visit code.
The proposed value of the code was based on 75% of psychiatric evaluation/psychotherapy code +90785, so the proposed work RVU was 0.25 with a physician time of 8.25 minutes.
For primary care, the proposed add-on code to be used with E&M code for the visit was GPC1X. This code applies to new and existing patients. It can include aspects of care management, counseling, or treatment of acute or chronic conditions. This code applies when other codes do not cover the primary medical care service provided.
The proposed RVU was 0.07 with physician time of 1.75 minutes. This has since changed due to commentary from the proposed fee schedule. Medicare has made the decision for the primary RVU to be the same as specialty, which means the new proposed RVU is 0.25 with a physician time of 8.25 minutes.
These add-on codes will definitely be something to watch for within these specified specialties and primary care as 2021 approaches.