A new study published in JAMA found that a new Medicare add-on billing code boosted pay significantly for specialists.
The study analyzed Medicare claims data from 2024, the first year that the G22111 was introduced. The code was billed 26 million times for 10.6 million patients, according to the study, generating about $394 million in payments.
Here are eight takeaways from the study:
1. Ishani Ganguli, MD, first author of the study and a primary care physician at Mass General Brigham and a searcher at Harvard Medical School, both in Boston, said that while the code was developed for PCPs, specialists utilized it more frequently.
2. The G2211 code was first introduced in 2021 as part of Medicare’s Physician Fee Schedule, according to a March 2 Medscape report, and aimed to boost compensation for providers “serving as the continuing focal point for all of the patient’s healthcare services needs,” or providing “ongoing medical care related to a patient’s single, serious…or complex condition (eg, sickle cell disease).”
3. Andrew Lyman-Buttler, MD, a third-year family medicine resident at the University of Minnesota, told Medscape that code’s reimbursement of $16.04 compensates doctors for the cognitive labor of following patients with complex diseases such as hypertension, diabetes, or polycystic ovary syndrome. This dollar amount adds up over time, he said, recognizing otherwise “unbillable work.”
4. Medicare rules prohibit the creation of specialty-specific billing codes, which meant CMS was unable to restrict the code’s use to PCPs alone.
5. Some associations of specialist physicians opposed the adoption of G2211 because improving payments to primary care would decrease payment to other areas of medicine.
6. In July 2023, 19 surgical societies authorized a letter to the director of CMS arguing that “this code will inappropriately result in overpayments to those using it while at the same time penalizing all physicians due to a reduction in the Medicare conversion factor that will be required to maintain budget neutrality under the PFS.” Despite this opposition, Congress green-lit the implementation of G2211 as part of a 2023 spending bill.
7. Specialist physicians, including urologists, nephrologists, geriatricians, endocrinologists, and rheumatologists, generated 43% of the 26 million G2211 codes billed in 2024, followed by primary care, which created nearly 40% of the codes.
8. However, primary care providers used G2211 for one quarter of eligible visits, compared to specialists, who only used G2211 for 13% of eligible visits.
