Primary care physicians support new Medicare code for ongoing, personalized treatment

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The new G2211 Medicare billing code is a much-needed medical and economic booster shot for primary care in the United States, supporters say.

But specialists are fighting it, arguing the code would overpay family physicians and internists while short-changing surgeons. Now both sides await congressional action or a shift in policy at the U.S. Centers for Medicare & Medicaid Services (CMS).

The American Academy of Family Physicians (AAFP) on Sept. 11 announced it has joined with 36 other health organizations to support G2211. They want Congress to do the same.

The code is scheduled to take effect on Jan. 1 next year. AAFP said the billing code “reflects the time, intensity, and practice expense needed to establish meaningful relationships with patients and address their health care needs with consistency and continuity.”

“Historic underinvestment in primary care has led to the fragmented, high-cost, hard-to-access health care system we have today,” AAFP President Tochi Iroku-Malize, MD, MPH, FAAFP, said in a news release.

“Primary care delivers robust health care at lower costs, and it is past time we match its value with investment,” she said. “The implementation of G2211 is an incremental but meaningful step toward rebuilding the foundation of primary care patients deserve: better health care, better outcomes, more primary care physicians, and lower costs.”

Surgeons say stop

The coalition of supporters, which includes the American College of Physicians, represents millions of physicians, other clinicians, patients, and members of the health care community, according to AAFP.

But not all of them. This summer, at least 19 organizations, led by the American College of Surgeons (ACS), announced they opposed code G2211, arguing it would hurt surgeons and patients.

“The ACS continues to advocate for a long-term, permanent fix to the broken payment system to enable better delivery of care for patients,” ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS, said in a news release.

“Congress can stop implementation of G2211, eliminate a majority of the expected 2024 Medicare physician payment cut, and not be required to expend any resources for this short-term solution,” Turner said.

What is it?

The various physicians agree Congress needs to improve reimbursement through CMS.

One proposal is add-on code G2211. CMS described its use for “furnishing services to patients on an ongoing basis that result in care that is personalized to the patient.”

“The services result in a comprehensive, longitudinal, and continuous relationship with the patient and involve delivery of team-based care that is accessible, coordinated with other practitioners and providers, and integrated with the broader health care landscape,” said a CMS fact sheet from 2021, the year CMS finalized the code.

At the time, CMS noted use of G2211 “is not restricted based on specialty,” though certain doctors would be more likely to use it than others. The information sheet included examples of using the code in primary and specialty care.

More for primary care

Congress postponed the start of G2211 until 2024 due to CMS’ required budget neutrality, meaning CMS can’t raise payments in one part of the physician fee schedule without lowering payment in another part, said Stephanie Quinn, AAFP senior vice president of advocacy, practice advancement, and policy. Quinn described the medical and legislative wrangling in her blog post, “The Simple Truth About Primary Care’s Complexity.”

“Lawmakers balked because CMS initially estimated the code would have high usage, which would have to be offset with payment cuts elsewhere in the fee schedule,” Quinn said. AAFP has long argued Congress needs to change budget neutrality, she added.

The surgeons’ opposition “forgets that primary care is the bedrock on which referrals are built,” Quinn said.

“It ignores that family medicine office visits really are more complex than those provided by other specialties, and that better payment for primary care services can improve patient health while promoting care continuity that reduces mortality, health care expenditures, and hospitalizations,” she said in the blog.

Suffering specialists?

FACS argued primary care physicians got their raises when CMS increased reimbursement in 2021, so G2211 is no longer needed.

The original rationale for G2211 was based on CMS’ proposal of a single payment rate for office/outpatient evaluation and management visit levels 2 through 5. That has been rescinded, granting new flexibility to bill higher-level codes for more time and complexity in making medical decisions, FACS said.

That makes G2211 redundant and unnecessary, according to FACS.

G2211 went on hold because Congress noted it would result in “significant payment cuts” for medical specialties, including a 3% cut for many surgical specialties, according to FACS. The College predicted implementing G2211 will “create concerning implications” for all physicians dealing with high inflation, and particularly for physicians performing minor procedures and providing imaging in rural and underserved areas.

The College agreed Congress has not created a long-term solution to the “broken” Medicare physician payment system.

“A flawed G2211 code on top of a broken Medicare physician payment system would be incredibly harmful to the health care system and not serve the long-term interest of patients,” the FACS statement said.