G-Codes for Medicare Electronic Prescribing Bonus

It is necessary to be using SOAPware 2010.1 (or later) in order to qualify for the e-prescribing bonus.

For additional information regarding this initiative, visit the CMS e-prescribing site.

Using the G-Code

Practices that meet the e-prescribing criteria will be eligible for a 2 percent bonus in 2009 and 2010, a 1 percent bonus in 2011 and 2012 and a 0.5 percent bonus in 2013. Practices not e-prescribing will face a 1 percent cut in 2012 and 2013. That cut will grow to 2 percent in 2014 and beyond.

In order to participate, physicians simply add the following G-code to their Medicare claims for patient encounters:

 

Shortcut: eRx

G-code: G8553      

Description: At least 1 Rx via qualified eRx system                                    

Explanation: All prescriptions created during the encounter were generated using a qualified e-Prescribing system

Notes

E&M services must be at least 10% of total allowed Medicare charges.

In addition, the physician must report the G-code, above, for at least 50% of the cases in which they apply (i.e..encounters with E&M codes).

The bonus  is based on total Part B payments and not just E&M

The Average bonus is around $1600/physician/year (e-prescribing is only $500/physician/year)

This eRx bonus  is in addition to other bonus programs such as the PQRI.

 

Additional Codes Needed

The G-code must be listed as an additional procedure code on the standard claim form. However, it appears the electronic prescribing G-code has to be listed with one of the below codes in order for the G-code to be valid.

   * (New Patient) 99201, 99202, 99203, 99204, 99205

   * (Established Patient) 99211, 99212, 99213, 99214, 99215

   * (Consultations) 99241, 99242, 99243, 99244, 99245

   * (Psych Services) 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809

   * (Behavioral Assessment) 96150, 96151, 96152

   * (Screening & Diabetic Training) G0101, G0108, G0109.

   * (Eye Codes) 92002, 92004, 92012, 92014

 

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