New Primary Care Billing Codes Introduced to MPFS

Primary care-focused billing codes have been introduced to the Medicare Physician Fee Schedule (MPFS) in an attempt to better support primary care physicians. A recent study published in the Annals of Internal Medicine by HCP professor Bruce Landon, MD, PhD, and colleagues, examines the potential value of these codes.

Using nationally representative claims and survey data of Medicare patients, a cross sectional modeling study was designed to measure frequency of use and estimated Medicare revenue involving 34 billing codes that have been added to the MPFS over the past 20 or so years representing services for which PCPs could but do not always bill.

Findings revealed that eligibility among Medicare patients for each service varied widely from 8.8% to 100%. Among those eligible, the median use of billing codes was 2.3%, even though PCPs provided code-appropriate services to many more patients eligible for each of the prevention services. It is estimated that if a PCP billed all provided prevention and coordination services to half of all eligible patients, the PCP could add to the practice's annual revenue $124 435 for prevention services and $86 082 for coordination services. However, because the projected revenue is based on survey questions, the number does not necessarily consider the cost of compliance, billing, and opportunity.

The study invites further investigation as to why PCPs seldom use these billing codes when they stand to gain considerable revenue treating eligible patients and are already providing code-appropriate services to some of those patients. More importantly, the study concludes that creating additional billing codes for distinct activities in the MPFS does not prove to be an effective strategy for supporting primary care.