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.
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.
