July 18, 2018

Medicare Payment Advisory Commission (MEDPAC) Reimbursement of Evaluation & Management Codes

by Continuum Health

MEDPAC recently issued a report to Congress. It reviewed the reimbursement levels for office-based E/M codes versus procedural codes. The commission recommended a significant increase in the reimbursement of E/M codes. The increase ranged from 5% to 30% as a pay increase.

The commission stated that over time there has been a “passive devaluation” of E/M codes. Specifically, encounter codes 99201-99205 and 99341-99350. were described as “underpriced in the physician fee schedule relative to other services, such as procedures.” The report suggested that this mispricing could cause problems with beneficiary access to these services.

The commission recommended that the Centers for Medicare and Medicaid (CMS) authorize additional research to determine the appropriate amount of the reimbursement increase for E/M codes. Payment for this change would come from a reduction of reimbursement for procedural codes. This reimbursement change would benefit specialists that make most of their revenue from E/M codes, namely endocrinologists, rheumatologists and family practice providers. Physical therapists, radiologists, and emergency medicine providers would see the largest net decline in revenue.

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