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The Final Rule for the Medicare Physician Fee Schedule for 2024 has been released giving us information needed for the upcoming year for services. This final rule details what Medicare/CMS will be making in the way of changes to any HCPCS (and CPT®) codes for the upcoming year. This includes both policies and procedures as well as codes. Although daunting at over 2,000 pages, it is information well analyzed.

CPT® made clarifications in their Split or Shared guidelines and these have a relationship to CMS’s new position on the visits which was unexpected from the direction they have been headed in for the past several years. Practices that have Non-Physician Practitioners (NPPs) need to fully understand these rules to avoid compliance issues. There will be discussion of new codes for Principal Illness Navigation (both Patient Navigator and Peer Specialist), Social Determinants of Health Risk Assessment and Community Health Integration. In addition, the newly payable code for visit complexity and its use are a part of this lecture.

Learning Objectives/Agenda

• What are the details of the change to Medicare’s Split or Shared visit policy for 2024?
• How has the selection of Prolonged Care codes in 2024 changed?
• What are the differences between the two sets of Principal Illness Navigation codes?
• How have the time tables changed for Office E&M services in 2024?
• G2211 – what is the code, how it should be used and who can/should use it?

Why is this topic important?

The Physician Fee Schedule (PFS) final rule is a powerful document that is often overlooked by practices in an office educating itself for the new year. Medicare has its own policies and procedures that are defined or updated within this final rule. If an office does not identify what changes, specific to their Medicare patients are happening, problems such as improper billing and coding of services, missing modifiers and ultimate lost revenue can occur. For example, the significant change in CMS policy for Split or Shared visits is a must to understand: what the policy in for 2024; what documentation is required needed; what locations can use the concept; what codes can it be used with. There are also new Social Determinants of Health codes that are new that should be understood as well. Payment for the Visit Complexity add-on code will also be discussed.

Who would benefit from this topic?

• Coders
• Billers
• Office Managers
• Practice Managers

What’s the presenter's background/expertise on this topic?

I am a consultant with over 30 years of experience. As an educator and as one who does updates lectures each year, I have the research tools and background on the subject to present this timely topic.

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