New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care

Cheryl Clark, for HealthLeaders Media , December 5, 2013

And it acknowledged the error of prior policies, saying that it realizes "the resources required to furnish chronic care management services to beneficiaries with multiple (that is, two or more) chronic conditions are not adequately reflected in the existing E/M codes."

While physician groups maintain that the doctors are doing this now anyway, and thank CMS for finally paying for it, perhaps a lot more is at stake. CMS is not just paying more, it also wants a more structured, systematic process within physicians' practices to make sure care coordination services are performed for these most complex patients. That's why they're now paving a way to pay for it.

CMS actually began paying physicians for non-face-to-face care in January 2013, but only for care coordination for patients transitioning from a hospital to a postdischarge setting or as spelled out in a few other limited pilot projects. "This [G-code] is much more significant in terms of the scope of the type of non-face-to-face services that they're going to be paying for," Erickson says.

The caveats

But of course, the rule imposes a few caveats regarding how G-codes can be used.

  • The patients eligible for G-code services must have two or more chronic conditions expected to last at least 12 months or until the patient's death and that place the patient at significant risk of death or functional decline.
  • The physician can bill for the services only once a month, but must document a minimum of 20 minutes doing this non-face-to-face activity each month. Even if the doctor's team spends five hours a month on these services, the payment will only be for 20 minutes.
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3 comments on "New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care"

Bonnie (1/15/2014 at 11:41 AM)
They should do the same thing for Medicaid, but that's not federal. A lot of times when everyone else makes sense, state laws do not. People will have to start bugging their state officials to come up with something for Medicaid patients, especially considering the pediatric population is highly likely to have families requiring physician services at odd hours.

RB (12/10/2013 at 9:20 PM)
When can doctors who take care of Medicaid patients, and not so much Medicare (think Pediatricians) get the same opportunity?

Kathy Johnson (12/5/2013 at 1:55 PM)
Can Rural Health Clinics that are paid by face to face encounters, now bill the non-face to face visits with the Gcode???




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