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Medicare hedges on billing rules

Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, interviewed on stage
Seema Verma, Administrator of the Centers for Medicare and Medicaid Services. Photo: Kate Patterson/The Washington Post via Getty Images

Physicians were furious earlier this year when Medicare proposed consolidating most billing codes for routine office visits into a single code next year. Medicare now says it won’t go that far or that quickly, but it will move forward with the general idea.

Why it matters: This affects billions of dollars in physicians' pay.

Driving the news: The Centers for Medicare & Medicaid Services said in a 2,378-page final rule yesterday that instead of collapsing 4 office visit codes into 1, it will collapse 3 codes into 1, and keep the highest-paying code.

  • Doctors would get paid $130 for most new patient visits and $212 for the most complex new patient visits.
  • Doctors would get paid $90 for returning patient visits and $149 for the most complex returning patient visits.
  • Those rates could be higher if doctors attach a special “add-on” code.
  • However, this will not go into effect until 2021 — giving doctors 2 years to ease into — or try to kill — the new rules.
  • When asked whether the agency would consider scrapping the rule before it goes into effect, CMS Administrator Seema Verma told reporters in a conference call: “No.”

The big question: It’s unclear whether the rule will address concerns of fraudulent billing, because the most lucrative code will still exist.

Medicare