New 2013 Coordination of Care Benefits to Increase Payments to Family Physicians

The 2013 Medicare Physician Fee Schedule adds new payments for care coordination services when transferring patients to skilled nursing facilities.  The new Current Procedural Terminology (CPT) codes (99495 and 99496) are the result of efforts by the AMA to get CMS to adopt new coverage for transitional care management services, such as discussing a care plan and supporting a treatment or medication regimen.

For these services, physicians (and qualified non-physician providers like NPs and PAs)

Stand to receive a fee of either approximately $160.00 or $230.00, depending on the complexity of the medical decision making the timing of the face-to-face visit.

CMS is expecting 2.17 million claims under these codes for total payments of $600 million, increasing payments to family physicians by about 7%.