CMS Proposes New Add-On Code That Will Finally Pay Interventional Pain Specialists For The Complexity Of The Care They Provide

As part of the proposed 2019 CMS changes in how Medicare will pay for Evaluation & Management (E/M) Codes, CMS has created a new code that may be “added-on” to each E/M code billed by any of ten specified medical specialties.  The “add-on” code is GCG0X and its CPT descriptor is “Visit complexity inherent to E/M associated with endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, cardiology, or interventional pain management centered services”.

By adding CPT code GCG0X to an E/M claim, the provider will receive an additional payment of $13.70 per E/M code to pay for the complexity of patients associated with their respective specialties. GCG0X may only be used when an E/M service is provided by one of the ten specialties listed in the GCG0X descriptor.  Other specialties may not use this code.  SPPM will keep you posted of updates as this proposal works its way through the legally required comment and review period.