Understanding the New Medicare G2211 Code

Revised on December 5, 2023, the New Medicare G2211 code for outpatient office visits can be found here Medicare G2211 Code

FAQ’s

Q. When will HCPCS code G2211 be implemented?
A. CMS is expected to begin reimbursing for code G2211 on January 1, 2024
The code adds a $16.08 payment to standard E&M payments

Q. Should code G2211 be used only for new patients?
A. No, it is an add-on code that can be listed separately in addition to office/outpatient E/M visits
for new or established patients (i.e., codes 99202-99215).

Q. Will code G2211 be covered by other third-party payers?
A. G2211 was created specifically for use on Medicare claims; therefore, there is no guarantee
that other payers other than Medicare will reimburse for this code.

2024 WRA Annual Meeting is September 13-15, 2024

Save the Date and plan to join us!
September 13-15, 2024

 

Dear Colleagues,

We are looking forward to gathering in person for the Washington Rheumatology Alliance Annual Meeting! Once again, we will be hosting the event at the charming Sleeping Lady Resort in the beautiful Cascade Mountains. Please join us from Friday, September 13th – Sunday, September 15th, 2024.

Attendees and guest speakers are welcomed to stay on site at Sleeping Lady Resort. We request that industry representatives stay at the Icicle Village Resort (just a few miles away from the conference venue) in the Bavarian-themed village of Leavenworth. There will be a discounted room block available.

If you are interested in exhibiting at the annual event, please complete the following form:
Exhibitor Interest Form

We look forward to seeing you this summer! Thank you for your continued support of the WRA.

Jeff Peterson, MD

WRA President

TAKE ACTION: Sign in ‘PRO’ to Share the Savings!

Washington’s own Share the Savings bill (SB 5445, HB 1465) is a measure that will help lower the cost of prescription drugs for patients throughout the state.

Share the Savings will improve the lives of Washingtonians who may struggle to cover out-of-pocket costs for medications and treatments by requiring health insurance companies and pharmacy benefit managers (PBMs) to share their negotiated savings directly with patients.

We need as many people possible to sign in ‘PRO’ before NEXT WEDNESDAY 2/1. It only takes 30 seconds!

➡️ Senate sign in HERE!

➡️ House sign in HERE!

Share the Savings

Health care is, unfortunately, a complicated system in the United States, with numerous players involved at every step. While the manufacturer makes the drug, the PBM contracts with the health insurance carriers to manage their prescription drug programs. PBMs are essentially the middlemen who negotiate rebates for the cost of prescription drugs and place medications within each health plan’s drug formulary. On average, manufacturers rebate 40% of a medication’s list price back to insurers or PBMs.

However, these rebates are really intended to be passed on to patients, which is particularly necessary for patients with health plans that utilize high deductibles or significant cost sharing. These patients are charged the full list price at the pharmacy counter, not the after-rebate price. PBMs and insurers pocket the savings from these rebates, while patients rarely see their fair share.

Share the Savings would fix that loophole by requiring 100% of rebates to be shared directly with patients – meaning patients see immediate savings at the pharmacy counter. Access to these rebates will help ensure patient adherence to their prescribed medications, as patients will often ration or stop medications if the over-the-counter costs are prohibitive. Share the Savings is one step that can help prevent patients from having to make that choice.

Drug manufacturers, health insurance companies and PBMs all play a part in delivering necessary medications to patients. The legislature has done much over the past few years to address the manufacturer’s role in drug pricing. Share the Savings ensures that we address other parts of the prescription drug supply chain that currently prevent savings from reaching the patients most in need of these rebates.

The WRA aim to expand access to healthcare and most importantly, improve the lives of the patients we treat. Share the Savings is one way to ensure Washingtonians can afford the lifesaving medications they need. We look forward to continuing this work to help all Washingtonians access innovative, affordable medicines.

Please don’t hesitate to reach out to learn more ways to engage on this effort!

CSRO Action Alert

Earlier this year, Congressman Ami Bera, MD (D-CA-07) and Congressman Larry Bucshon, MD (R-IN-08) introduced legislation to provide relief for the large Medicare Physician Fee Schedule reimbursement cuts that are currently set to take effect on January 1, 2023.

This legislation, Supporting Medicare Providers Act of 2022 (H.R. 8800), would provide a one-year “hold harmless” payment to offset the looming reductions in the Fee Schedule. The bill also establishes a “Sense of the Congress” that the Department of Health and Human Services and the Congress should commit to:

  1. ensuring financial stability and predictability in the Medicare physician payment system;
  2. promoting and rewarding value-based care innovation; and
  3. safeguarding timely access to high-quality care by advancing health equity and reducing disparities.

H.R. 8800 already has over 80 bipartisan cosponsors, but your support is needed to urge Congress to act on this bill.

Visit the CSRO Action Center to convey your support TODAY. With just a few keystrokes, you can send our template message to your representatives and make a lasting impact.

 

Thank you for getting involved!

Take Action Now

Downloadable Resources from the Arthritis Foundation

The Arthritis Foundation has free downloadable brochures and fact sheets through the AF Store​ that you can save to your office desktop. The brochures and fact sheets can be e-mailed to patients or you can print copies in-office and hand out to patients as needed. The downloadable materials are a convenient way to provide your patients, who may not be comfortable taking printed materials from your office as a result of the Covid-19 pandemic, the information they are looking for. Instructions are available here.

If you are in need of a bulk order of printed brochures or fact sheets, please contact your local Arthritis Foundation staff member at Washington@arthritis.org for assistance.

The Arthritis Foundation also created a Covid-19 Resources flyer that has a list of great patient resources to help them navigate the pandemic and stay connected.

Interstitial lung disease exacerbates rheumatoid arthritis activity, related conditions

Patients with interstitial lung disease demonstrated a higher proportion of comorbidities and rheumatoid arthritis activity, as well as rheumatoid arthritis-related conditions, according to a presenter at the EULAR 2020 Virtual Congress.

“Interstitial lung disease is a common extra-articular manifestation of RA, and is known to be associated with increased morbidity and mortality,” Gary Craig, MD, of Discus Analytics and Arthritis Northwest, both in Spokane, Washington, told attendees in the session. “Studies have shown substantial variability in the prevalence, clinical characteristics and risk factors of RA-associated ILD, or RA-ILD.” Click here to read the full article.

New Resources Added to WRA Website

CreakyJoints
https://creakyjoints.org/

CreakyJoints is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. All of our programming and services are always provided free of charge.

  • Education: Constantly updated and informed by the latest research, our educational articles and comprehensive patient guidelines help newly diagnosed and experienced patients as well as caregivers understand their diagnosis, symptoms, and traditional and complementary treatment options. We also provide advice regarding how to communicate effectively with health care providers, insurance companies, and the stakeholders who write our health laws and policies.
  • Support: Through our interactive social media channels, CreakyJoints members can directly connect with the arthritis community and ask questions of health care professionals who participate in regularly scheduled webinars and #CreakyChats. Visit us on Twitter (@CreakyJoints), FacebookYouTube, and Instagram (@Creaky_Joints) for a 24/7 hive of positive support.
  • Advocacy: We believe that patients need to participate in all conversations that relate to our access to treatment, safety, or the quality of our care. Through our 50-State Network, we train and help patients living with any diagnosed, chronic illness to amplify their voice and add their personal perspective to health policy discussions happening in Washington, D.C., the state capitals, hearing rooms, regulatory meetings and other public forums. Whether adding your name to a petition, speaking in front of lawmakers, or contributing an opinion article to your local newspaper, we invite you to join our network to influence the future of health care in the United States.
  • Patient-Centered Research: Created by CreakyJoints and supported by a multiyear, multi-million dollar investment by the Patient-Centered Outcomes Research Institute (PCORI) as well as additional public-private partnership support ArthritisPower is the first-ever patient-centered research registry for joint, bone, and inflammatory skin conditions. The free ArthritisPower mobile and desktop application allows patients to track and share their symptoms and treatments while also participating in voluntary research studies in a secure and accessible manner. ArthritisPower Patient Governors serve as gatekeepers for researchers who seek to access registry data or solicit the community to participate in unique, voluntary studies. Since 2016, 45 ArthritisPower studies were published in peer-reviewed journals or presented at major medical meetings as abstracts or posters, in partnership with major universities, research institutions and industry. To learn more and join ArthritisPower, visit www.ArthritisPower.org.

Discus Analytics
http://t3jointman.com/

Discus Analytics, LLC., is a healthcare company specializing in the capture, analysis, and application of actionable clinical data, and believes that specialists who implement a data collection portal capable of tracking patient outcomes and quality metrics in real-time have a decided advantage within the changing landscape of healthcare reform.

For Patients: Making Telehealth Easy
http://t3jointman.com/for-patients-making-telehealth-easy/

For Providers: Telehealth Helpful Tips and Coding Cheat Sheet
http://t3jointman.com/for-providers-telehealth-helpful-tips-and-coding-cheat-sheet/

For Providers: How to use the Doxy.me Conferencing Platform
http://t3jointman.com/for-providers-how-to-use-the-doxy-me-conferencing-platform/