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Medicare Paying E and M's at a Flat Fee

Tierni Posted Fri 03rd of May, 2019 14:41:53 PM
Hello, We are hearing through the grapevine that Medicare will be paying a flat fee in 2019 for 99212, 99213, and 99214, but I can't find any information on this. Can you please help us out?
SuperCoder Answered Mon 06th of May, 2019 03:58:56 AM

Hello Tierni,

You have the right information. Medicare will be paying new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate) while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215 (99211 would be paid a lower rate). The level 1 codes don’t get the flat rate because they don’t require the presence of a physician.

However, CMS will not make any E/M payment changes until January 1, 2021. For 2019 and 2020, CMS will continue to use the current coding and payment structure for outpatient E/M visits, and practitioners should continue to use the 1995/1997 guidelines to document them. Hope it helps.

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