ID add-on code proposed in new CMS fee schedule
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Key takeaways:
- If approved, the add-on code would be implemented in 2025.
- The add-on code could be applied to hospital inpatient and observation care by infectious disease clinicians.
CMS included a new infectious disease consult add-on code as part of its proposed new fee schedule could help improve compensation for ID clinicians, according to the Infectious Diseases Society of America.
Last fall, IDSA identified increased compensation for ID clinicians as one of its policy priorities for 2024, specifically aiming to lobby members of Congress and CMS to “level the playing field” so that the specialty can improve recruitment and retention of young doctors.
CMS announced its proposed 2025 Physician Fee Schedule in July, which includes a cut to physician payments — this year, of 2.93% — for the fifth straight year. According to the AMA, physician payments have dropped 29% since 2001, which experts have said will hinder care for beneficiaries, worsen ongoing workforce shortages and strain physician practices.
For ID clinicians, there is good news in the proposed fee schedule: new add-on code that is expected to increase compensation for work in the specialty. We asked Amanda Jezek, senior vice president for public policy and government relations at IDSA, what the add-on code could mean for both ID clinicians and health care facilities.
Healio: What is the proposed add-on code and how will it be used?
The HCPCS add-on code would describe the intensity and complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease performed by a physician with specialized training in infectious diseases.
CMS says the new add-on code, HCPCS code GIDXX, could be applied to hospital and inpatient evaluation and management (E/M) services to describe service elements, including disease transmission risk assessment and mitigation; public health investigation, analysis and testing; and complex antimicrobial counseling and treatment. The proposed relative value for the new code is 0.89. Under the proposed conversion factor, that translates to a $28.80 boost to hospital and inpatient E/M services where the code is appended.
Healio: How does the add-on code benefit ID clinicians?
Current E/M codes do not adequately capture the complexity of ID physician services. This add-on code is intended to help better account for that complexity and provide a mechanism for ID physicians to receive additional reimbursement (on top of what E/M codes provide) when providing this complex inpatient care. (There is already a different add-on code — G2211 — implemented at the beginning of 2024, for complex outpatient care that is not specific to ID.)
Healio: Does IDSA expect the code to be approved?
The add-on code was included in the Medicare Physician Fee Schedule Proposed Rule that was put forward by CMS. CMS is accepting public comments on the rule through Sept. 9, and IDSA encourages all ID physicians to express support for this add-on code. IDSA will be submitting comments are working with several Congressional representatives on a bipartisan letter in support of the add-on code, and we will provide our members with opportunities to weigh in directly with CMS.
CMS is expected to publish its final rule later this year, and it will take effect next year. The more strongly we collectively express support, the better our chances of ensuring its inclusion in the final rule. Inclusion in the proposed rule is the first step, and often the most challenging, so this progress is significant.
Healio: Why was this a focus on IDSA’s advocacy on behalf of ID physicians?
Ensuring fair compensation for ID clinicians that accurately reflects the tremendous value of ID care has been a longstanding priority for IDSA, as we know that ID care is undervalued, and that inadequate compensation is one key challenge hindering ID recruitment and retention. The add-on code is one of several IDSA initiatives to help boost ID compensation and strengthen the ID workforce.
References:
- IDSA advocacy delivers significant victory for ID in proposed edicare fee schedule. https://www.idsociety.org/news--publications-new/articles/2024/idsa-advocacy-delivers-significant-victory-for-id-in-proposed-medicare-fee-schedule/. Published July 11, 2024. Accessed Aug 1, 2024.
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