By Marie Rosenthal, MS
The Centers for Medicare & Medicaid Services (CMS) recently included a new add-on code for infectious disease physicians in its calendar year 2025 Medicare Physician Fee Schedule Final Rule. The new code would go into effect on Jan. 1, 2025.
Because ID services depend more on cognitive actions than procedures, codes for ID specialists have been few and did not reflect the complexity of managing infectious diseases, according to the Infectious Diseases Society of America (IDSA). The new add-on code creates a “mechanism to more appropriately value complex ID services that are not adequately captured and valued in existing codes,” the society said in a statement.
The final Healthcare Common Procedure Coding System (HCPCS) add-on code describes “the intensity and complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease performed by a physician with specialized training in infectious diseases.”
The new code, HCPCS code G0545, includes hospital and inpatient evaluation and management services to “describe service elements, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment.”
The final relative value unit for the new code is 0.89 with a total time of 30 minutes. Under the proposed conversion factor, that translates to a $28.80 boost to hospital and inpatient evaluation and management services where the code is appended.
The new add-on code, as finalized by CMS, would provide an additional payment for the following complex inpatient services when provided by an ID physician:
• disease transmission risk assessment and mitigation;
• public health investigation, analysis and testing; and
• complex antimicrobial therapy counseling and treatment.
Historically, coding involves procedures rather than the cognitive skills required for treating and managing infectious diseases, therefore the IDSA has been championing this code with CMS for years. The society has garnered bipartisan support for it with congressional representatives, led by Reps. Jefferson Van Drew (R-N.J.), Jason Crow (D-Colo.) and Debbie Dingell (D-Mich.), sending a letter of support for the add-on code to CMS.
IDSA has undertaken significant advocacy to ensure that the new add-on code was maintained in the final rule, including submitting a comment letter about the provisions in September. More than 550
IDSA members supported the code directly to CMS through an IDSA Action Alert.
CMS has confirmed that code G0545 can be used for one or any combination of the three service elements, and recognizes that each service element may not be medically appropriate for all ID patients. CMS also has clarified that this add-on code recognizes “the inherent complexity for all infectious diseases and not just emerging infectious diseases with epidemic potential.”
Bonnie Kirschenbaum, MS, a pharmacist and an expert in payor issues, told Infectious Disease Special Edition that the add-on code is long overdue, but acknowledged that commercial payors may not follow CMS’s lead, which would leave their beneficiaries without the same coverage. G codes are typically established through notice and comment rulemaking that supports Medicare claims; they may be used by other third-party payors, but not aways, she explained.
“This section of the final CY2025 PFS rule that applies to ID physicians provides long overdue recognition of the importance of prompt recognition, diagnosis and attention to infectious disease both in hospitalized patients, as well as those in observation status which may last for days. The rule which becomes effective Jan. 1 still may be subject to modifications based on additional comments submitted to CMS,” she wrote in an email.
It will be important for facilities to update their electronic health record system to accommodate any supporting documentation, she added. “Paying attention to coding is crucial.”
