Summary of Chargemaster Updates

Effective Jan. 1, 2021

Applicable to all physicians using Intellicure wound care software.

The following summary explanation is provided by the Intellicure leadership team to help Intellicure users further understand the changes made to their physician chargemasters.

Codes 99417 and G2212

Now that time is a primary method for accounting for a visit, and because visits can certainly last longer than the times allotted for the most comprehensive code, the AMA has developed a new CPT code for 15 minutes of prolonged care, done on the same day as office/outpatient codes 99205 and 99215. The new code is 99417. The new codes are suitable for use with new and established office visits.

CMS and the AMA are not in agreement about the use of prolonged care code 99417, resulting in CMS assigning 99417 a status indicator of invalid and developed a new HCPCS code to replace it, G2212.

Code G2211

CMS created this new code that is to be used by physicians in combination with E/M codes to represent care delivered to patients with a higher medical complexity. This replaces the HCPCS placeholder code GPC1X that CMS talked about in prior rules, and we now have a definition and instructions on when to use it.

CMS believes that even with the increase in RVUs for office visit codes, that the payments still do not reflect the complexity and expense associated with caring for patients in a primary care practice and certain other specialties, such as wound care. The increased payment is for the resources associated with: “a comprehensive, longitudinal, and continuous relationship with the patient and involves delivery of team-based care that is accessible, coordinated with other practitioners and providers, and integrated with the broader health care landscape.”[1]

G2211 can be used by any specialty, including visits reported with modifier -25.

CMS is not restricting its use to primary care, and specialists who care for a patient with a particular disease over a long period of time may also use it.

[1] 2021 Calendar Year Physician Fee Schedule Final Rule, page 275