07/15/2024
How Oncology Practices Can Ethically Boost E/M Payments
Evaluation and management (E/M) visits are often the bread and butter of an oncologist’s coding lineup. It isn’t every day that practices can boost their E/M pay by reporting add-on codes; however, Medicare has made that possible in 2024, thanks to the addition of new reimbursement policies for code G2211.
As many oncologists are aware, the Centers for Medicare and Medicaid Services (CMS) began allowing payment for add-on code G2211 effective January 1, 2024. The descriptor reads, “Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established).”
CMS was clear in the 2024 Physician Fee Schedule final rule that the code should be reported along with an E/M visit (such as codes 99202–15). However, some practices were still curious about whether the agency would issue specific coding guidance to better clarify how it should be used. Fortunately, that happened on January 18, when CMS released a fact sheet with G2211 specifics.
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