NEJM August 15, 2018
The Medicare payment policy for evaluation and management services — the most commonly billed type of physician services in the United States — has long attracted scrutiny. Tasked with rewarding cognitive work by physicians that is commensurate with patients’ needs while minimizing the potential for fraud, Medicare pays for office visits using five levels of codes based on clinical complexity, medical decision-making complexity, and time. For visits with established patients, physicians are currently paid $22, $45, $74, $109, and $148 for levels 1, 2, 3, 4, and 5 visits, respectively; for new patients, they receive $45, $76, $110, $167, and $172. This pricing structure in the Medicare Physician Fee Schedule, established by Congress in 1989, is the basis for physician...
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