We understand the challenges of keeping current on how to code and bill for your Medicare patients appropriately. Below are a few resources to help you ensure that you are paid appropriately and do not violate any Medicare policies.
Medicare鈥檚 New Add-on Code G2211
Starting January 1, 2024, CMS implemented the new Medicare add-on code G2211 to better recognize and reimburse the resources necessary to provide patients with longitudinal, continuous care. G2211 will allow clinicians to account for services like chronic disease management tracking, review of consultative or diagnostic reports, and medication monitoring. CMS created this new code to capture these previously unrecognized elements of continuous, longitudinal care based on a clinician's relationship with a patient. Beginning on January 1, 2025, CMS will allow payment of the G2211 add-on code when reported by the same clinician on the same day as an annual wellness visit, vaccine administration, or any Medicare Part B preventive service.
Office and outpatient E/M visits can serve as the continuing focal point for all needed health care services, making them comprehensive and often complex. For more information on the use and reimbursement for G2211, members should review ACP鈥檚 informational sheet, video supplement, and the Outpatient Services learning module in the Coding for Clinicians series. As part of ACP鈥檚 Coding for Clinicians subscription series, members should be on the lookout for updates to the learning module on G2211 which will go into greater depth and cover additional aspects of billing and reimbursement.
ACP continues to work with CMS to ensure clinicians are receiving reimbursement, additional guidance is widely available to all clinicians and their teams, and the code is covered across Medicare and Medicare Advantage payors as appropriate.
Quality Payment Program (QPP)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition physicians away from a volume-based system toward one that rewards value.
Learn moreTelehealth Guidance and Resources
Offering guidance on clinical use cases, technology, regulations and waivers, and billing and coding.
Getting Started with Medicare
- : Free tools from CMS that allow doctors and their staff to learn about a broad range of Medicare related issues.
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- Additional information on Ordering and Referring from the AMA: Ordering/Referring Fact Sheet
Additional Payment Issues under Medicare
- ACP Comments on 2025 Physician Fee Schedule, Medicare Shared Savings Program, and Quality Payment Program Proposed Rule
- ACP Summary of 2025 Physician Fee Schedule, Medicare Shared Savings Program, and Quality Payment Program Proposed Rule (ACP login required)
- ACP Summary of 2023 Medicare Physician Fee Schedule (MPFS) & Quality Payment Program (QPP) Final Rule (ACP login required)
- Read ACP鈥檚 Comments on 2023 Final Physician Fee Schedule & Quality Payment Program Rule
- HIPAA
How to Comply with Medicare Regulations
Advance Care Planning
- Advance Care Planning Tool Kit: This tool kit helps practices implement and bill for Advance Care Planning and end-of-life discussions. (ACP login required)
Chronic Care Management
- Chronic Care Management (CCM) Tool Kit: This new tool kit provides what practices need to implement the new CCM codes, including background information for clinicians and staff, a step-by-step implementation guide, and a sample patient agreement. (ACP login required)
- Resources from CMS:
Transition Care Management Codes
Preventive Care Visits
- Initial Preventive Physical Examination
- Annual Wellness Visit
- : This is an interactive PDF, in which you can click on a service at the left to view that service's information.
Home Health Face-to-Face Encounter Requirement
Care Plan Oversight Encounter Worksheet and Instructions
Care Plan Oversight Encounter Worksheet and Instructions (ACP login required)