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CMS Fee Schedule Changes – New Physician Add on Code

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NCCI Report on 2024 CMS Fee Schedule Changes + New Physician Add on Code

CMS fee schedule changes impact a large number of states.  NCCI recently released its yearly evaluation report on any Centers for Medicare and Medicaid Services – CMS Fee Schedule Changes and the effect on Workers Compensation fee schedules.  The PDF can be found here. 

The US map analyses of how CMS effects Workers Comp is worth the download.  An example of one of the maps appears at the end of this article. The darker blue states rely more on the CMS fee schedule to set Workers Comp medical reimbursement rates.

I remain a proponent of medical fee schedules.  Having a cost basis when setting workers comp reserves always helps an adjuster assess future medical costs on claims.

The summary of findings by NCCI in the 2024 CMS Fee Schedule update are listed below.

  • Effective January 1, 2024, CMS initially published the physician conversion factor of 32.7442, which was a 3.4% decrease from 2023. Subsequently, Congress passed the Consolidated Appropriations Act, 2024, which included a temporary payment increase of 1.7%, effective March 9, 2024. This change increased the conversion factor to 33.2875, a 1.8% decrease from 2023, from March 9 through the end of 2024.
  • CMS added a new code to the physician fee schedule in 2024. This code, G2211, is an evaluation and management add-on code. The extent to which this code will impact physician costs will depend on how commonly physicians utilize the code in WC.
  • Facility base rates saw moderate increases that were in line with the increases seen in prior years.
  • The 2.6% increase to the CMS DMEPOS update factor in 2024 is significantly lower than the increases seen in 2022 and 2023 of 5.1% and 8.7%, respectively.

 

US Map CMS fee schedule changes for 2024
(c) NCCI – Boca Raton, FL

CMS Fee Schedule Changes – G2211 Add on Code

Let us see what the G2211 code from CMS. The NCCI article used the CMS update found here as a reference.

Beginning January 1, 2024, CMS is finalizing implementation of a separate add-on payment for healthcare common procedure coding system (HCPCS) code G2211. This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care. Generally, it will be applicable for outpatient and office visits as an additional payment, recognizing the inherent costs involved when clinicians are the continuing focal point for all needed services, or are part of ongoing care related to a patient’s single, serious condition or a complex condition.

Bottom Line

The CMS fee schedule changes affect a large number of states.  An update on the G2211 add on code will show up in a future article.  Each state that uses the CMS fee schedule will interpret how the new code will be used in 2024 and beyond.

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2 Responses

  1. I want to say that this post is amazing, great written and includes almost all significant info for workers compensation. I will visit this website often and subscribe to it today.

  2. Thanks for the upvote. Check back every Thursday evening US Eastern Time Zone. We release two articles per week on Thursdays. We now have 6,500 readers. Please use the blog for reference on Workers Comp. Have a good day.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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