Medicare Preventative Services

CMS is proposing to implement section 4104 of the ACA, which provides Medicare Part B coverage of an “Annual Wellness Visit Providing Personalized Prevention Plan Services.” CMS is proposing payment for these new Medicare services through the use of two new HCPCS G Codes. Yet, CPT already has codes that could be used for these services. The AMA, therefore, urges CMS to work through the established CPT Editorial Panel and the RUC process to adopt these existing codes for these services.

The AMA continues to have strong concerns about CMS’ development of HCPCS G codes instead of requesting the development and valuation of appropriate codes through the CPT Editorial Panel and the RUC. Development and valuation of codes through this regular process avoids massive billing confusion and ensures credibility of the coding process. There is an enormous amount of effort and expertise that is required by each specialty in developing coding proposals, conducting surveys to determine physician time and work, convening consensus panels, and determining appropriate direct PE inputs for each new CPT code that is created. The results of these efforts are then validated through multi-specialty groups of physicians, including CPT Advisors, the CPT Editorial Panel and the RUC. This process provides stability and credibility to the development of a code, and ensures that code descriptors and recommended RVUs are developed and maintained by physician experts who represent those providing these new services.

Further, the AMA strongly supports better coverage for Medicare preventive care, and we commend implementation of preventive care benefits. We urge CMS, however, to address several important issues related to implement of this ACA provision.