Primary Care and Codes Specialists Must Know

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  • May 08, 2019
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Medicare Proposes New Codes for Specialists in 2021

A new rule relating to the Evaluation and Management (E/M) was proposed in 2019 by Medicare Physician Fees Schedule (MPFS). The codes help certain specialists to evaluate the reimbursement. This rule which is yet to be implemented is postponed to 2021, the MPFS also discussed that the same code will be used by the E/M office/outpatient levels. The add on code would be used to add reimbursement in the combined E/M payments.

Let us see what is all about the add-on proposed Primary care codes for specialists which are temporarily termed as GCGOX:

  • It would estimate additional resource costs for specialties that have E/M visits which may be more than the allowed charges.
  • specialties are normally up to 4 and 5 visits.
  • The specialties more often than not use the E/M codes than the separate codes for the treatment involved.

The specific specialties listed are essential to evaluation and management, those cases relating to endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, or interventional pain management-centered care. There is a separate list, add-on code to E/M visit.

Interactive Complexity lists separately apart from the primary procedure. Therefore the proposed Relative Value Unit (RVU) was 0.25 for a physician time of 8.25 minutes.


This is applicable to the new and existing patients.

  • The phases of care management, counseling, or treatment of acute chronic conditions can be inclusive.
  • This code is applied when other codes do not cover the service provided.
  • It can also be used as an add-on with E/M codes for primary care service visits.

The RVU proposed was 0.07 with a physician time of 1.75 minutes. Medicare also mentioned that there were questions as to why the primary code valuation was lower than the specialty code’s. At the discretion of the Medicare, it decided to change the work RVU to 0.25 with a physician time of 8.25 minutes in its final rule so that the primary care codes and specialty codes go hand in hand. These codes are yet to be implemented in 2021, there are chances that the code and valuation may change before such time.

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