Everyone agrees that primary care visits are the cornerstone of healthcare, providing thoughtful and complex care to ensure patients' needs are met. However, the catch is that the hard work of primary care physicians has historically been woefully underpaid. Fortunately, there's a game-changing solution on the horizon, set to roll out in 2024: HCPCS code G2211. The code is specifically designed to ensure fair compensation for the complex, high-value care and coordination provided by primary care physicians, ultimately leading to better outcomes.

Studies have consistently shown that primary care office visits are lengthier and more complex than those conducted in other specialties. Primary care physicians must navigate a wide range of acute and chronic conditions, providing ongoing preventive services, counseling patients, and addressing behavioral health challenges and social needs, all within the confines of a brief visit. G2211 is the latest attempt in coding to recognize and account for this additional complexity and its related practice costs.

The Medicare physician payment system operates on the principle that payments should reflect the resource costs of providing services. Since primary care visits involve more physician work due to their complexity, G2211 aims to better account for these resources and is a much needed add on code to ensure primary care is adequately compensated.

If you look at the average Medicare reimbursement for a mid-level established patient E&M service (CPT 99213) across the country, it is approximately $100 (with some variation based on geography). G2211 would reimburse an additional $16.05 per visit.

This new code along with those for counseling related to smoking cessation, weight management, alcohol use, depression screening, chronic care coordination and transitional care management were designed as additional reimbursement for primary care, but they are incredibly underutilized. As an example, a study published in Annals of Internal Medicine found that nearly 9% of older adults still smoke. Among them, 61% reported receiving advice from a health care professional to quit smoking, but only 10% of the 9% had a claim for smoking cessation counseling.

G2211 is a long-overdue solution to the underpayment of primary care physicians. Not billing for these codes, which are services that 100% are happening on a daily basis in primary care practices is a tremendous, missed revenue opportunity and is something that should be on the radar for 2024 to benefit both healthcare providers and patients alike.

Interested in learning more? The team at VisiQuate is focusing on how we can help hospitals optimize their revenue cycle management. Visit our Revenue Cycle Playbook for step-by-step plays to help you stay on top of the ever-changing landscape of healthcare revenue cycle, or contact us to schedule a demo.

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