American Institute of Healthcare Compliance – Evaluation and Management (E/M) Visits

December 1, 2023

American Institute of Healthcare Compliance – Evaluation and Management (E/M) Visits

Beginning January 1, 2024, the Centers for Medicare and Medicaid (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.

Split (or shared) Evaluation and Management (e/M) visits

Split (or shared) E/M visits refer to visits provided in part by physicians and in part by other nonphysician practitioners in hospitals and other institutional settings.

  • For CY 2024, CMS is finalizing a revision to the definition of “substantive portion” of a split (or shared) visit to include the revisions to the Current Procedural Terminology (CPT) guidelines, such that for Medicare billing purposes, the “substantive portion” means more than half of the total time spent by the physician or nonphysician practitioner performing the split (or shared) visit, or a substantive part of the medical decision making.
  • This responds to public comments asking that it be allowed that either time or medical decision making to serve as the substantive portion of a split (or shared) visit.

Click here for more PFS information from CMS

Click here for the November press release which provides a summary of changes