Historically, payment for cognitive, nonprocedural care has required provision of face-to-face evaluation and management as part of general ambulatory or inpatient care. Although non-face-to-face patient care (e.g., care via electronic means or telephone) is commonly performed and is integral to patient-centered care, appropriate reimbursement for this type of care is lacking. Beginning in 2017, Centers for Medicare and Medicaid (CMS) has taken a large step forward in reimbursing an increased number of cognitive care and non-face-to-face codes. CMS has also included language indicating that nonphysician providers (i.e., nurse practitioners and physician assistants) can perform many of these services independently. The 2017 and now the 2018 fee schedules thus create new payments for non-face-to-face, patient-centered services, and may allow neurologists to reach out to more patients through nonphysician providers. As health care in the United States moves toward value-based incentives, these newly supported non-face-to-face services will provide neurologists with new tools to deliver sustainable, high-value care.
Bibliographical noteFunding Information:
W.G. Mantyh reports no disclosures. B.H. Cohen serves on a DSMB for Stem Cell Transplantation for MNGIE and as Chairman, External Advisory Board of Clinical Protocols, Neurofibromatosis Consortium, Department of Defense; has received speaker honoraria from the American Academy of Neurology (AAN); serves as the AAN advisor to the CPT panel; serves on the editorial boards of Pediatric Neurology and Mitochondrion; receives publishing royalties for Mitochondrial Case Studies, Underlying Mechanisms and Diagnosis (Academic Press/Elsevier, 2016); serves as a consultant for Stealth Biotherapeutics; receives research support from Bioelectron Technologies, Horizon Pharmaceuticals, Stealth Biotherapeutics, Reata Pharma, and NIH (grant NIH 5U54 NS078059-06); serves on the Board of Trustees of United Mitochondrial Disease Foundation; and is a medicolegal consultant to the US Health and Human Services for the Division of Vaccine Injury Compensation Program. L. Ciccarelli is a full-time employee of the AAN (Senior Manager, Reimbursement & Coding). L.M. Philpot reports no disclosures. L.K. Jones serves on the editorial board of Neurology: Clinical Practice; receives publishing royalties for Mayo Clinic Neurology Board Review (Oxford University Press, 2015); and has received teaching honoraria from the AAN. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.