Webinar: Navigating the 2025 Medicare PFS Maximize Revenue and Simplify Billing

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Discover how Medicare changes in 2025 could shape your practice. Learn from industry experts Kelly Schoenfeld and Brian Esser how to adapt seamlessly, optimize revenue, and support patient care. This webinar is hosted in partnership with Elation Health.

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Host: Brian Esser, Principal Product Manager at Elation Health
Speaker: Kelly Schoenfeld, CEO of Zoo Health

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00:00:00:00 - 00:00:43:04

Brian

Hello, and thank you for joining our webinar today. We're going to give about one minute for everyone to come in to the virtual doors. And then we'll get started.

00:00:43:06 - 00:01:11:18

Brian

All right. Well good morning, everyone, and welcome to our webinar on the 2025 Medicare Physician Fee Schedule. Final rule. We're excited to have you here as we break down the major updates impacting primary care practices. And today's session will focus on important changes, including advanced primary care management, EMR visit add on codes, new modifiers, and much more. I'm Brian Esser, principal product manager at Elation Health.

00:01:11:21 - 00:01:35:13

Brian

Very nice to see you here. I'm working primarily on our billing, product election billing and ad election healthcare, empowering physician groups and primary care doctors to deliver phenomenal patient care with our suite of tailored, clinical, first all in one solutions. And we've also had great success with our AI powered Scribe Note Assist. You can see that in my background here.

00:01:35:15 - 00:01:55:27

Brian

Allowing you to reclaim face time with patients and reduce after hours work. Be sure to look for the free in-app trial and take it for a spin. If you're a current user doing, some due diligence here. Want to remind you that this webinar is being recorded and will share the recording with you afterward. So don't worry if you miss something.

00:01:56:00 - 00:02:19:26

Brian

Before I hand it over to our expert here, Kelly Schoenfeld. Let me give you a quick walkthrough of today's agenda. We're going to start with the overview of the final rule. We're going to cover a PCM code that's advanced primary care management. Is it add ons, post-operative care changes, telehealth updates, fee schedule adjustments, and more.

00:02:19:28 - 00:02:42:24

Brian

A lot to cover today. But without delay, we're going to get right into it. We will wrap up with the Q&A session to address your questions. And in the meantime, you can look for the question mark chat bubble in your go to meeting webinar and drop your questions in there, throughout the webinar. And we will do our best to answer them.

00:02:42:27 - 00:03:04:27

Brian

Anything that we can't cover, we will reach out to you directly, but we would love to hear from you. There. With that, I'm thrilled to introduce Kelly Schoenfeld, CEO of Zoo Health, one of the nation's preferred revenue cycle management partners. Kelly is bringing extensive experience in healthcare operations and revenue cycle management with more than a decade of experience.

00:03:05:00 - 00:03:31:14

Brian

Elation users can also take advantage of Zoo Health's 2025 Easy Transition program, offering two months of free RCM services. With that, Kelly, we really appreciate you being here and I will pass it over to you so we can dive right in. All right. Thank you for the wonderful introduction, Brian. And thank you, everyone, for attending today.

00:03:31:16 - 00:03:58:05

Kelly

As stated, we will be discussing the Medicare Final Rule for 2025. There's a lot to discuss, so let's go ahead and jump right in here. Each year, the centers for Medicare Medicaid Services CMS issued a final rule for Medicare programs, including the physician fee schedule. The final rule addresses public comments on the proposed rule and updates the rules, estimated costs and benefits, to determine payment for a particular service.

00:03:58:06 - 00:04:23:21

Kelly

The Medicare fee schedule geographically adjusts relative value units RV use. I'm sure all the physicians in here are well acquainted with that. They reflect the physician work and cost of providing that service and then multiplies. Those are begins by a dollar amount known as the Medicare conversion factor, also set by the CMS. So let's take a quick minute to define terms.

00:04:23:23 - 00:04:48:15

Kelly

This I think is probably the most boring part of the presentation. All the code stuff I'm most excited about. But do our diligence here. RV use or calculated based on three components the work RV you. This is the physician's technical scale physical effort, mental effort, judgment, stress related to the patient outcome. The most crucial component is the time required to perform a service.

00:04:48:18 - 00:05:11:06

Kelly

The second one is the practice expense review covers the overhead costs of running the practice, such as rent, equipment supply, staff salaries, basically, you know, everything extraneous, malpractice, RV use the third one reflects the costs associated with professional liability. I'm sure most of you are paying for liability insurance. And you know how expensive that can get.

00:05:11:09 - 00:05:41:16

Kelly

Once the total RV was calculated multiplied by the conversion factor. Basically, conversion factor determines whether payments to physicians will go up or down, which we'll visit in a second. Also in play is the Medicare Economic Index, meaning the measure used by CMS to estimate the annual changes in the cost of operating medical practice. It's a key component in determining medical or Medicare reimbursement rates for physicians and other health care providers.

00:05:41:19 - 00:06:12:18

Kelly

So how is that applied? The economic index typically factored in, to Medicare physician fee schedule, often in conjunction with other legislative rules or cost containment measures like the conversion factor. While the MI estimates cost changes, actual payment updates may be influenced by budget neutrality requirements or policy changes. Basically, under current law, the projected cost of all changes to the physician fee schedule must be budget neutral.

00:06:12:19 - 00:06:33:18

Kelly

That is, the changes may not raise total Medicare spending by more than 20 million in a year. The AMA is actually trying to work on that and fighting against that to raise that budget. So, reimbursement can go up for physicians. So we'll see how that plays out. But the bigger picture here, what's going on? What does it mean to me?

00:06:33:20 - 00:07:04:00

Kelly

The Medicare conversion factor for 2025 is $32.35. This is a 2.83% decrease from last year. So in other words, reimbursements or for physicians are going down. Not good news, right? Even worse news reimbursements have been decreasing for five straight years now. So this makes it more important than ever to make sure you're utilizing the new CPT codes that we did get for Medicare.

00:07:04:02 - 00:07:26:10

Kelly

Make sure you're billing for all procedures you're currently performing and, make sure you're aware of new revenue streams that may be available to you, such as chronic care management, remote patient monitoring. Those immediately come to mind. So with that, let's get into some of the new codes and some of the codes you probably aren't using, but you should consider.

00:07:26:12 - 00:07:58:15

Kelly

The first one of those is the advanced primary care management codes. See that slide just came up. One of the most significant changes is these codes 0556 557 558. These codes simplify payment by bundling care management services and reflect patient complexity rather than rigid time thresholds. The result is practices can reduce or administrative burden while ensuring fair compensation for their efforts.

00:07:58:17 - 00:08:27:11

Kelly

So these are new chronic care codes basically that are tied to a time limit. Some of you may know about chronic care management that codes 99 for 90. That does have a time limit of at least 20 minutes. So this is kind of an alternative pathway. Because the first code, G0556 are patients that only have one chronic care condition.

00:08:27:13 - 00:08:53:18

Kelly

Generally for CCM, you have to have at least two. So they broke this into pieces, these three different codes. But so the first one, one chronic condition that's expected to last a significant amount of time, commonly at least a year or until the patient's death. These services are offered by clinical staff under the guidance of a physician or other qualified health care professional who accepts a main point contact.

00:08:53:21 - 00:09:32:05

Kelly

So what does that mean, personally? I've seen practices used nurse practitioners to manage these chronic, care patients. The code is billed per calendar month. So this is a monthly code. And right now reimbursement for that is right around $16. Of course, that's going to vary on where you're at, you know, geographically. The second code in this bundle, G0557, are services for patients with more than one chronic condition, generally to at least or more significantly increase their risk of serious complications or decline.

00:09:32:07 - 00:10:04:00

Kelly

This is also reported monthly, reflecting continuous team based management of multiple chronic conditions. Reimbursement for this is right around $51. So that's not far off from 99490. Which is about $63. And the last one, this is a kind of a special one that is looking at a patient's economic status is G0558 focuses on services specifically designed for Medicare beneficiaries who have multiple.

00:10:04:02 - 00:10:31:06

Kelly

So two or more chronic care conditions. And they're also qualified Medicare beneficiary. So, basically, to be eligible for that, you have to be entitled to Medicare Part A, have an income at or below 100% of the federal poverty level. And have resources at or below the Medicare Part D low income subsidy. So, patients with limited financial resources have two or more conditions.

00:10:31:06 - 00:10:52:04

Kelly

Reimbursement on that is actually pretty decent at $112, per usage of that code. So for these codes, and this is for all the builders out there, there are a couple of common errors that you should be aware of. You have to make sure there's no overlap, that occurs with other care management codes for the same patient within the same month.

00:10:52:06 - 00:11:20:26

Kelly

These codes can only be billed once a month per patient. Medicare will deny your claim. If you're over billing it. It might even open the door to an audit. Nobody wants that, right? Do not bill CPT code 994 90 along with this. That one is time based and conflicts with the PCM codes. And then keep in mind, I think I mentioned earlier, 9949 requires the 20 minutes, 20 minutes spent with the patient.

00:11:20:29 - 00:11:49:13

Kelly

That's not necessarily, you know, for the rest of those eight BCM codes. So you need to follow payer specific guidelines for monitoring, documentation and reporting. Thorough documentation is critical. There's or omissions can quickly lead to denied claims. This includes monthly clinical activities transitions of care, care plan updates, patient interactions. And much like chronic care management. You have to provide 24 seven access for patients.

00:11:49:15 - 00:12:10:13

Kelly

So round the clock communication options. If you're working with anything with like remote patient monitoring and you have, you know, somebody has a heart rate of 150, somebody is going to need to contact that that patient. So a lot of the chronic care, requirements are also met with these codes. They just give you a little more flexibility.

00:12:10:15 - 00:12:36:28

Kelly

So, the fee and fees and reimbursement rates for these codes, are higher due to the level of coordination required. However, Medicare and commercial insurance insurers may have varying policies, so it's important to confirm coverage before billing. Also strongly recommended to let patients know of any potential cost sharing obligations. For transparency, for example, G0558, the Q and B,

00:12:37:00 - 00:13:05:11

Kelly

They may require a small Medicaid copay to let them know that ahead of time. But when you implement these codes, it may seem like reimbursement is not so much, but it quickly adds up. And we're here to help you add those dollars up. So, even if you saw 200 patients in your population and build the G0557, can quickly get over 10,000 a month, over 100,000 annually.

00:13:05:17 - 00:13:37:23

Kelly

So there's definitely a cumulative effect. And with that, let's move on to another exciting code, G 2211 and get the slide up. This code was actually introduced in 2024. They've been playing around with it. Medicare has kind of changed some of the things involved with this code. Starting in 2025. It can be built alongside the base M code for visits that include preventive services.

00:13:37:24 - 00:14:10:02

Kelly

This is super, super important. So that's exams, labs, other tests and screenings in the office. So 20 2211 serves as an add on to existing M services when patient needs go beyond routine care. So when can you use it? The associated M service. So you're looking at those codes that are like, you know, 99213, two and four, two and five or, you know, new patient visits.

00:14:10:02 - 00:14:49:05

Kelly

It's reported with modifier 25, but only if the additional service is a Medicare Part B preventive service, previously billing 2211 with the modifier 25 M was not allowed. So they've changed things around a little bit. With this you are going to use the 25. But you've got to show these are additional separate services. So you also build it when additional effort isn't accounted for by the standard M you're going above and beyond, but you got to make sure you're documenting this, when you're doing simple things, like immunization administration.

00:14:49:07 - 00:15:17:16

Kelly

You can also plug that on, when you're providing ongoing care for serious conditions like glaucoma or age related macular degeneration. Also below that. So here's like a little example of what you could build in the office. You may be able to do, you know, a nine, 9 to 1 three and G 2211 and also Bill for an annual wellness visit.

00:15:17:19 - 00:15:40:28

Kelly

So there's different configurations. All meant to put a little bit more money in your pocket to reward you for the extra work that you're doing and taking care of these patients. So when can't you use it? You can't use it when patient provider relationship is not ongoing or the provider doesn't plan to take on ongoing care.

00:15:41:01 - 00:16:07:16

Kelly

But if it's a one off, like a mole removal or consultation for an acute issue. Can't use it if the visits an urgent care center visit. Or if the visits an inpatient emergency department, nursing home or home setting. Visit. So to get paid for this, basically, it's really important to document everything you got to document the complexity.

00:16:07:18 - 00:16:32:28

Kelly

Clearly outlining the patient's condition, extra work involved in managing their care. So fees and reimbursement for this code. Medicare set and allowable rate for 2211, around $16. Once again, while this amount might not, well, might it might seem modest. Also accumulate value. They add up. You're adding all these extra codes to your end codes.

00:16:33:00 - 00:16:56:28

Kelly

You will feel that. And it's a nice way to get some extra bucks. So code G 2211 is more than just a billing line opportunity to enhance your practice's revenue while ensuring your efforts in providing high quality care. Are recognized. Okay. So, with that, we're going to go ahead and move on to the next code in the system.

00:16:57:00 - 00:17:26:04

Kelly

And that is G55, nine. And this will also be the first mention of modifier. So this may not be relevant to your practice. It may be relevant, to some of you out there that, you know, do perform surgeries. These are changes you need to know about. An adjustment to modifier 54 has been introduced, introduced to better reflect realistic care transitions.

00:17:26:06 - 00:17:56:18

Kelly

The transfer of care modifier 54. Now applies to all 90 day global surgical packages, addressing situations where post-op care is handled by a different provider. Additionally, the new add on code 0559 compensates providers who are following up care for surgical patients during their work is properly, reimbursed. So, what is the code price to post-op follow up visits you provide?

00:17:56:18 - 00:18:28:08

Kelly

When the surgery was performed by another practitioner outside your group, you're helping the patient's recovery during the standard 90 day global period. There's no formal transfer of care, meaning the original surgeons still hold primary responsibility for the patient's post-op course. The code captures the complexity of these visits, including reviewing surgical notes, examining the patient for procedure specific complications, communicating with the operating surgeon is needed.

00:18:28:10 - 00:18:53:14

Kelly

By documenting these extra steps to ensure proper reimbursement. For the care you provide. When can you use it? If your, post-surgical fall exam to a patient whose original surgery occurred within the past 90 days? The key requirements include, a different practitioner. You or your group are distinct from the practitioner who had performed the surgery.

00:18:53:16 - 00:19:22:19

Kelly

No transfer of care. Original surgeon retains primary responsibility for post-op care management. You're within the 90 day global period. Visit must occur within the 90 day global period for the surgery. Added complexity. You performed a detailed evaluation, reviewed the surgical records, and addressed any complications or concerns. Medicare has this, some very specific scenarios where this code cannot be used.

00:19:22:22 - 00:19:48:22

Kelly

On the flip side of the coin here. Same provider or group? That code is intended for a different practitioner than the one who performed the surgery. If you're part of the same group, this code does in a Pi transfer of care. You can't build this code if you fully taken over the patient's post-op management. Regional surgeon must still be considered the primary person for that patient's follow up care, or beyond 90 days.

00:19:48:22 - 00:20:20:18

Kelly

If the post-op visit occurs after the standard 90 day global period. The G0559 no longer applies. Normal evaluation and management codes are typically used instead. So, to ensure successful reimbursement, be sure to document thoroughly detail your post-op evaluation process. Include notes about the surgery, patient exam findings, any communication with the original surgeon. Demonstrating the extra complexity just helps justify this code.

00:20:20:21 - 00:20:43:09

Kelly

Verify the global period. Make sure you're in that 90 day window. You can use this G0559 with the M codes. So you build them in addition to your standard office outpatient evaluation management visit code for the encounter. And of course ensure there's no overlap in care responsibilities or formal transfer of care, which would disqualify the use.

00:20:43:12 - 00:21:05:06

Kelly

So the reimbursement on this is around $9. Like I said, some of these don't seem like much, but they'll add up if you're involved in these, things, in these situations, a lot. For any of you out there that may be hospitalist or have hospital privileges, you can build this code with your normal inpatient CPT codes.

00:21:05:06 - 00:21:45:02

Kelly

So you might see something like nine, nine, two, three and three, plus G0559. So this is something you could definitely put in your pocket and build for, modifier 54. This code has existed, but there's, significant change with it. Per 2025 Medicare physician fee schedule. It's a 54 modifier will be required now for all 90 day global surgical packages when a practitioner only performs the surgical procedure portion, essentially mandating the use of transfer of care modifiers in all relevant scenarios.

00:21:45:04 - 00:22:10:25

Kelly

So key points about modifier establishing a broader use of transfer of transfer of care modifiers. So those old code include 5455, 56. These modifiers will be required for all 90 day global surgical packages when a practitioner only performs a part of the package like pre-op, post-op. Even if there isn't a formally documented transfer of care.

00:22:10:27 - 00:22:41:22

Kelly

So for modifier 54, that's for surgical care only when one physician performs the procedure and another provides post-op pre-op care. And then modifier 55 is, you know, whoever the physician is, it's doing the post-op management. So, hopefully, you know, this isn't too hard to follow. You're trying to keep this moving along, going kind of fast and furious because there's so much content to get to.

00:22:41:23 - 00:23:08:10

Kelly

So forgive me if it's going quick, but, you know, feel free to be, asking questions in the chat there. And, even if we can't get to you right away, we will get back to you. There are questions on that. Any case, it's going to get a little more complex because now we're going to talk about telehealth and so we're finally changing the slides, moving up further here.

00:23:08:12 - 00:23:42:26

Kelly

There we go. Okay. So telehealth is going to be an interesting one because some of this is actually still in flight right now. And that's regarding originating sites. So the code in question is Q3014 involved in ongoing legislation. Key parts of this are at the close of 2024, US Congress passed the short term extension of Medicare telehealth flexibilities as part of the American Relief Act.

00:23:42:28 - 00:24:13:20

Kelly

The Medicare telehealth waivers originally enacted in the first place. With Covid 19, I'm sure everybody remembers that. And it was subsequently extended through legislation. All of that was set to end on December 31st of last year. So the era extended extended that, and and currently now it's set to expire March 31st. So we'll see if they're working on that.

00:24:13:20 - 00:24:44:03

Kelly

And they extended, but basically, people were going to have to report to originating sites instead of being able to, conduct telehealth visits from their own, you know, place of residence. So, the geographic restrictions and originating sites, are important. If this does not get extended, patients homes will. Or if it does get extended patients homes will continue to serve as eligible sites.

00:24:44:05 - 00:25:15:15

Kelly

The geographic restrictions are going to be waived. The expanded definition of the term practitioner will continue to apply. And that definition includes occupational therapists, physical therapists, speech language pathologist and audiologists. Also, they want to, keep it. Where are the audio only telehealth services remain eligible. Before I think you you might have had video component that was needed, but you can just do audio only.

00:25:15:18 - 00:25:44:24

Kelly

Telehealth services for February, Federally Qualified Health centers and rural health clinics have been extended. And there's one really huge one for everybody that's involved in behavioral therapy. They were going to set the new requirement that that needed to be in-person visits. But, Congress has extended. And waived, the in-person requirement until April 1st.

00:25:44:26 - 00:26:18:00

Kelly

So basically it need to see what Congress is going to do, see if they keep the status quo, which seems like it would be the easiest. Otherwise, code 23014 represents, you know, the telehealth originating site, facility fee. And, these facilities are going to have to take, people in and be kind of the, the way spot for, for people to see the doctors that way.

00:26:18:02 - 00:26:44:02

Kelly

So, the facilities that are originating sites, you know, they have to be a private space for telehealth sessions. They have to have telecommunications technology onsite, staff support. The main reason of this new code is to ensure patients in rural and underserved areas can access high quality care without traveling long distances. So when can you use this code?

00:26:44:04 - 00:27:10:01

Kelly

You know, assuming that things don't get extended. Facilities can bill 23014 when they serve as the originating site for telehealth, visit under the following conditions. Patient must be in a Medicare designated rural or underserved area. You have to verify eligibility by using Medicare's geographic tool before submitting claims. You have to be approved originating site.

00:27:10:04 - 00:27:39:29

Kelly

Can be hospitals, clinics, health centers, nursing facilities. The patient's physical presence at the site is mandatory. Services must comply with Medicare's telehealth guidelines. And Medicare is specified that this code cannot be used if the patient access is telehealth services from home, or any location that does not meet Medicare's definition of an originating site. So yeah, there was a lot of uproar about this people.

00:27:40:00 - 00:28:08:07

Kelly

You know, our home, they want to be, you know, not have to leave the comfort of their home and still be able to see their physician. And so far, so good that is staying in place. But just good to know this information in case that changes. For 2025, the reimbursement for this code is 80% of the lesser of the actual charge, or $31.01.

00:28:08:10 - 00:28:33:03

Kelly

So basically, you know, it's going to be around $30 just to host these telehealth visits. So, here's a few things to keep in mind. Most Medicare plans cover this code, but private insurers may have specific requirements, including the dreaded words prior authorization. So I'm sure everybody knows about prior us. So you will have to have that.

00:28:33:05 - 00:28:55:02

Kelly

There's a cost sharing for patients. Medicare beneficiaries may have co-pays or deductibles for telehealth visits. And for patients about potential out-of-pocket costs. You always want to collect copays upfront, as I'm sure you know. And a lot of times insurances actually require that of you. And especially when it's telehealth, if you don't have the patient there.

00:28:55:04 - 00:29:19:01

Kelly

It's it's better to get that money in your pocket, today than try to chase it tomorrow. So, this code 23014, if we get there, can be billed for each telehealth session. But excessive, unjustified billing may trigger audits or denials. So once again, be careful, how you use that code. But this is a very much wait and see situation.

00:29:19:04 - 00:29:41:21

Kelly

To see if things get extended. So the two deadlines we were looking at are March 31st generally and behavioral health April 1st. Specifically. And so with that, let's keep cruising along and talk about, cardiovascular risk assessment and management.

00:29:41:23 - 00:30:15:18

Kelly

Hope you guys are hanging in there with me. Okay. So these are two new codes G0537, G0538. So 537 covers a standard cardiovascular risk assessment. This should last 5 to 15 minutes and billable just once per year. So this code supports early detection by looking at things you would expect, you know, cholesterol, blood pressure, lifestyle factors, which helps guide measures.

00:30:15:18 - 00:30:44:25

Kelly

And the targeted therapies, that you give the patient. So G0538. That's not the annual one. This is kind of a monthly, monitoring. So it focuses on the monthly cardiovascular risk management recovery medication adjustment. So if you're taking blood pressure meds up or down, lifestyle coaching follow ups, and ensures consistent care for patients with known cardiovascular risks.

00:30:44:28 - 00:31:09:19

Kelly

So when can you use them? Conveniently enough, you can use them with several of the codes we've already talked about. So, patient comes in, you can build for a nine, nine two and for the G code 20 to 11. And you can also do this G0538 all together. And that's where, I keep bringing up, you know, there's a cumulative effect.

00:31:09:21 - 00:31:34:22

Kelly

These are all like little box you're putting together and they're all dollars, and it's, rewarding you for giving the patient excellent care, which I know that's all you care about, right? But you got to keep the doors open to. So G0537 is the initial risk detection. It's ideal during preventive or annual wellness visits. So that'll be, you know, like G0439.

00:31:34:22 - 00:32:02:13

Kelly

I'm sure you guys know about that. It's only billed annually as discussed. Reimbursement for this is right around 20 bucks. That's an approximation depending on, you know, where you practice G0538 is the ongoing management. So that's, you know, your medication oversight follow that's designed for patients with ongoing risk who require routine touch points. And the reimbursement for that's about $16.

00:32:02:15 - 00:32:25:14

Kelly

So you have to make sure your documentation clearly supports each code. To avoid denied claims. Medicare has specific scenarios where this code cannot be used. And they don't want you to exceed frequency limits. So G50531 once a year. Don't try to report it any more than that. Might be nice if you just set it up.

00:32:25:16 - 00:32:46:06

Kelly

It had a reminder to do it at the top of each year. Just get it out of the way and get paid for it right in the middle of deductible season, which everybody loves. G0538. Make sure that you're building that monthly. You don't want to overlap with other monthly care codes unless there's a clear distinction in the activities performed.

00:32:46:08 - 00:33:11:06

Kelly

Any duplication of services? Medicare generally does not allow billing G053 7 or 5 three eight in the same period. If those activities are already accounted for under another code. So once again, I'm bringing up chronic care management or remote patient monitoring. Those some of those cover the same tasks. So you may not be able to report these codes separately.

00:33:11:09 - 00:33:42:09

Kelly

In a non cardiovascular context. These codes are specifically addressing cardiovascular risk. So if your documentation focusing on other conditions and not that it's not related Medicare could deny the claim. As anything else you will also need to look at your diagnoses codes to demonstrate medical necessity. You know so a patient that's a good qualify for this might have chest pain.

00:33:42:11 - 00:34:07:15

Kelly

Obesity, obesity, high blood pressure. You wouldn't necessarily want to have like, a diagnosis code of a headache. You probably won't get paid for that. Right. It makes perfect sense. Okay, so let's, move on from that and let's go to the caregiver training codes. And it looks like we got about ten minutes that I am trying to wrap this up.

00:34:07:17 - 00:34:33:22

Kelly

So the caregiver training codes are G0541542 and 543. And so when can you use them. So these are three codes, related to scenarios where caregivers, are being trained by the physician. You know, safe, practical measures to care for patients outside of a clinical setting. So it can be used in the following scenarios. Face to face instruction.

00:34:33:25 - 00:35:05:16

Kelly

Provider or physician is teaching, skills directly to the caregivers. Number two, patient should not be present. This focus is exclusively on teaching caregivers rather than providing direct patient care. Number three, extended sessions. G0542 is an add on code. So any 15 minutes beyond the initial, you get to charge for that. And then the last piece of that is group training which is the G0543.

00:35:05:19 - 00:35:41:19

Kelly

When the provider's instructing multiple caregivers in a single session. So the five for one covers the first 30 minutes. And those sessions focus on things like, how to provide wound care, infection control, pressure ulcer prevention. The reimbursement for that is $54, so not too bad. 542 as I mentioned, additional 15 minutes. Then you get to tack on another 2650 and then, G0543 where you're training, group members and there's multiple caregivers.

00:35:41:21 - 00:36:06:27

Kelly

That one is $23.39. So these codes recognize the value of caregiver education, enabling you to deliver hands on and structured instruction that, improves patient care. But you also have to capture reimbursement for your time. So make sure you document the session was caregiver focused and that the patient was not involved. Patient can't be involved.

00:36:06:29 - 00:36:30:03

Kelly

Don't forget to confirm that the training meets clinical guidelines, for preventing complications and improving quality of life. Once again, there's always situations or scenarios where you cannot use these codes. To go through a few of those patient, the patients present during training cannot build them. If patients there. There's no link to the patient condition.

00:36:30:03 - 00:37:02:27

Kelly

So you have to have training that's addressing the patient's documented needs to qualify. If there's inadequate documentation, claims require detailed records of time, techniques taught, and caregiver roles. So you must have all of that, overlapping services. You can't build this code alongside others, you know, covering the same activities. And frequency limits. Some payers always some payers, may impose limits or require prior off.

00:37:02:27 - 00:37:38:24

Kelly

There's pressure off again for repeat sessions or group training. So moving right along. Kind of wrapping up and summing up. AP codes allow you to provide patients with a wide range of services to meet their individual needs based on complexity. And this is chronic care management without the time, based requirement. Billing for these services uses a monthly bundle instead of billing for each individual service or recording minute by minute.

00:37:38:26 - 00:38:03:06

Kelly

The G 2211 is an add on code. Recognizes additional time and complexity involved in relationship based care. So starting in 2225, it can be billed alongside the basic code for visits. And mentioned this earlier. This is really important. It's all the preventive services like the exams, lab tests, screenings, all of those things are going on.

00:38:03:06 - 00:38:30:25

Kelly

And so you attach this code on to the M code, to get paid a little bit more appropriately. Modifier 54 and code G0559. Those ones are all about, physician surgeries and managing post-op care, pre-op care and the cardiovascular codes we discussed. You have the two codes. One is, general screening that you'll probably want to do at the top of the year.

00:38:30:27 - 00:38:55:12

Kelly

The G0538 is the one that you'll want to do on a monthly basis to follow along and just meds for patients. And the one we just discussed, the caregiver training codes G05412543 which outlines the types of training that can be given as well as the requirements and and recommendations for billing them. But anyway, we're getting real close to the end here.

00:38:55:15 - 00:39:14:11

Kelly

Before we get to the Q&A portion, I'd like to thank all of you for attending today. You could have chosen to be anywhere else, but you made the effort to be here. I really appreciate that. And I know health does, too. We care about you as customers. And if you're not a customer yet, we hope you join us.

00:39:14:13 - 00:39:43:18

Kelly

And I hope that shining through. Please reach out if you need any help with your billing. I am always available to you. And, with that, I'll hand it over to Brian for the Q&A. Thank you so much, Kelly. Very much appreciate, all the great information. As we knew it was going to be jam packed. So we do have limited time for questions if we do not address, your question, we will follow up, via email, after the webinar.

00:39:43:18 - 00:40:02:00

Brian

So, keep a lookout for that. So I will, go ahead and rapid fire a few things to you. One is, can I build the eight PCM codes and the chronic care management codes together?

00:40:02:03 - 00:40:28:14

Kelly

No, you have to. You're going to have to pick one track or the other. So it'll be considered a duplication of service. So if you, if your patients are mostly, if they have one condition or two conditions or, you have a lot of the calls qualified Medicare beneficiary, you probably would like to go along with the app.com track.

00:40:28:16 - 00:40:49:26

Kelly

And that might be a good fit for you, but for those, that are interested in chronic care management, there are partners that we work with. And those are all basically, two conditions that are expected, you know, to go to the end of the year or the end of the patient's life. That would be another track that you could do.

00:40:49:26 - 00:41:18:29

Kelly

But you can't do both. You have to pick one track because one's time based, the other is not. So it would be just a series of of questions, you know, like, what's best for your practice. And we have to sort through that. Okay, great. And, I think one thing we can highlight is that, while you have to choose either a PCM or CCM for a patient, both of those can be combined with remote patient monitoring.

00:41:19:01 - 00:41:44:22

Kelly

So that's good to know. Our PCM codes billed at the end of the month, like the CCM. I can answer that one. I believe they're built at the beginning of the month, different from CCM. Yeah. Chronic care management is definitely, the end of the month. Generally, for that, we would get a report generated for all the codes, all the patients seen and all the work done.

00:41:44:22 - 00:42:08:18

Kelly

And at the end of the month, give doctors the reports of what happened. And so, yeah, it's a little different at PCM. Top of the month chronic care management back end of the month. Okay. Great. Question came through about the G codes. Are these G codes one time per month or per year? Looked like it was a mixed bag.

00:42:08:18 - 00:42:41:28

Kelly

Most of the G codes covered, could be billed monthly. There was the cardiovascular screening code. That was once per year, and g 20 to 11, separately, can be used alongside regular M codes. Also had a question about the difference of G 2211 and G 2212. A quick highlight on that. G 20 to 12 is a time based extension.

00:42:42:00 - 00:43:05:10

Kelly

Where G 2211 is, about complexity in the context of longitudinal care and not just a, time extension. Right? Yeah. It's something you got to look at some of those codes, especially when they're back to back, like we talked about the caregiver training codes like G0541 and then five four 2 or 5 four one the first 30 minutes.

00:43:05:12 - 00:43:26:01

Kelly

And then, you know, tacking on 15 minutes is the next step of code, you know, plus one and, and, I think that is the same thing for chronic care management, which we didn't, go into, like with nine, nine, 490. I think, additional minutes is something like 99 439. And I got so many codes going through my head.

00:43:26:03 - 00:44:02:24

Kelly

But so, yeah, there's always the initial, the initial base code and then the extension of time code that you could put on. And so like for G 2211 G 2212 is that. Yeah. So we had another question about can these codes be built by NPS or only MDS? Oh, okay. That's that's an interesting one. Some of these I specifically mentioned that, practices will use NPS to manage their chronic care patients.

00:44:02:26 - 00:44:36:22

Brian

That's pretty standard. And there's, you know, a whole Medicare rule to about billing incident, to which I'm sure, most people out there know about, generally if an MP pas is submitting claims to the insurance company, the insurance companies take, reduction off of the reimbursement. So maybe they need to get paid at 80%. But if you follow the Medicare rules for incident two, you could bill at the physician level and not get any of that money cut out.

00:44:36:25 - 00:45:03:25

Kelly

So it's, really great situation because, you know, MPAs could be really helping out with the practice, and they can be building the codes, and you build it in such a way that it's under supervision of the provider. So it's a win win situation. But yeah, NPS MPAs, can build these codes, particularly if you're in a state where they allow full autonomy.

00:45:03:27 - 00:45:30:14

Kelly

I think we're just signing on a practice right now that's in Iowa, where they do have that, so, position NPS are, you know, writing prescriptions, doing, you know, most whatever a physician would do, hopefully that others that are practicing independently. I think we have, two more quick questions and we'll have to wrap up and definitely reach out, for these other questions.

00:45:30:17 - 00:45:52:19

Brian

To the audience, on email. So please look out for that. We have an answer for this one. Two does providing, patients with a phone number for a 24 hour answering service count as 24 hour care? The answer on that one is, unfortunately, no, not by itself. There must be access to, a clinician.

00:45:52:22 - 00:46:25:27

Brian

So the way some people are accomplishing this hour after hours nurse triage services, along with on call clinician rotations. But a 24 hour answering service, alone does not meet the requirement. Finally, Kelly, what resources would you, suggest to help prepare and look further into these changes? Oh, yeah, it's a good question. And it's, the answer is the same thing I use to prepare for this, you know, presentation.

00:46:26:00 - 00:46:52:03

Kelly

Going to Medicare directly their website, they get cms.gov. They have options where you can sign up and get, you know, daily newsletters. They let you know new activity, new codes, changes, you know, to the rule for 2025, maybe updates on, you know, what's going on with telehealth. That's a really good place to get information.

00:46:52:06 - 00:47:17:03

Kelly

Also, another good place to get information is my website. It's zoo Dot health. There's no.com zoo dot health. And if you go on the expert advice section you'll see all of these codes there. We have a lot of information there. We try to keep that updated regularly. We even have our own newsletter. We like to keep our providers well informed on what's happening.

00:47:17:05 - 00:47:38:27

Kelly

And of course, if you know what's happening and if you know what codes that you can, you know, newly built to increase revenues, we're all about that. We want, you know, our practices to make more money, be successful, grow, keep the doors open and, take care of patients for sure. So I would go to CMS, dot gov or go to zoo dot health expert advice.

00:47:39:00 - 00:48:04:15

Brian

You'll be able to find a lot of this information there. Thank you very much. And these codes are active here starting 2025. Elation billing has all these codes preloaded ready for you to start, billing them. So thank you all for joining us today. We appreciate your time. We'd like to remind you to please reach out to us, and we will also send you this recording for, elation Health.

00:48:04:15 - 00:48:24:15

Brian

We provide an all in one year and practice management solution designed for independent practices like yours. If you haven't checked out notice just yet, by the way, again, you can sign up for a free trial directly in the application if you're not already an elation customer. Encourage you to book a demo with us at Elation Healthcare.

00:48:24:16 - 00:48:44:14

Brian

Com forward slash demo to see what elation can do for your practice. And if you're considering medical billing services, Zoo Health is here to help with their 2025 Easy Transition promotion. You can start improving your RCM with wildly efficient medical billing. Getting your first two months free. You can contact Kelly Kelly at Zoo Health or book at discovery.

00:48:44:14 - 00:49:01:14

Brian

Call it Go Zoo Dilation or excuse me, go dot zoo dot health forward slash elation. Thanks again for joining us. We look forward to helping your practice thrive in 2025.

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