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Medicare Payment and Regulations Resources

We understand the challenges of keeping current on coding and billing for your Medicare patients appropriately. Below are resources to help you ensure that you are paid appropriately and do not violate any Medicare policies.

What’s New

Telehealth: In CY 2025, several changes were made to the coding and payment of telehealth services. CPT codes 99441-99443 are no longer available. Physicians should use existing E/M codes (99202-99215) with a –93 modifier for audio-only services and a –95 modifier for audio/visual services. Additionally, CPT code 980216 has replaced HCPCS code G2012 for virtual check-ins.

G2211: Starting January 1, 2024, CMS implemented the new Medicare add-on code G2211 to better recognize and reimburse the resources necessary to provide patients with longitudinal, continuous care. CMS created this code to capture these previously unrecognized elements of continuous, longitudinal care based on a clinician's relationship with a patient. The code was recently updated to allow payment of the G2211 add-on code when reported by the same clinician on the same day as an annual wellness visit, vaccine administration, or any Medicare Part B preventive service. More information on G2211 can be found in ACP’s Coding for Clinicians subscription series.

Quality Payment Program (QPP)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition physicians away from a volume-based system toward one that rewards value.

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Telehealth Guidance and Resources

Offering guidance on clinical use cases, technology, regulations and waivers, and billing and coding.

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Getting Started with Medicare

  • : Free tools from CMS that allow doctors and their staff to learn about a broad range of Medicare-related issues.
  • - Withdrawing or Opting Out of Medicare

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How to Comply with Medicare Regulations

Advance Care Planning

  • Advance Care Planning Tool Kit: This tool kit helps practices implement and bill for Advance Care Planning and end-of-life discussions. (ACP login required)

Chronic Care Management

  • Chronic Care Management (CCM) Tool Kit: This new tool kit provides what practices need to implement the new CCM codes, including background information for clinicians and staff, a step-by-step implementation guide, and a sample patient agreement. (ACP login required)
  • Resources from CMS:

Transitional Care Management Services

Preventive Care Visits

Home Health Face-to-Face Encounter Requirement

Medicare Improper Payment Review

Advanced Beneficiary Notices (ABN)

Medicare Part D Resources