Primary Care First (PCF) Model: Updated Appendix B - Prohibited Healthcare Common Procedure Coding System (HCPCS) Codes
The purpose of this Change Request (CR) is to provide updates to the list of Primary Care First (PCF) Appendix B Prohibited HCPCS codes, which are specified under CR 11896. The updated Appendix B will apply to related PCF CMS CRs including: CR 11419, CR 11896, and CR 11911. Of note, HCPCS code G2211 (Add-On Code for Prolonged E&M with direct patient contact) is being removed from Appendix B so participants can bill this code and receive payment as per the Physician Fee Schedule final rule, effective January 1, 2024. Contractors shall utilize the updated Appendix B provided in the attachment to this CR. Additionally, contractors shall go back to reprocess and accept claims for HCPCS code G2211 received on or after January 1, 2024, from Primary Care First participants, adding payments as necessary
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 02, 2024
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