Medicare Payment for Cognitive vs Procedural Care Minding the Gap

JAMA: August 12, 2013


Importance   Health care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment. Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health.

Objective   To quantify the Medicare payment gap between representative cognitive and procedural services, each requiring similar amounts of physician time.

Design   Observational analytical study comparing the hourly revenue generated by a physician performing cognitive services (Current Procedural Terminology [CPT] code 99214) and billing by time with that generated by physicians performing screening colonoscopy (Healthcare Common Procedure Coding System code G0121) or cataract extraction (CPT code 66984) for Medicare beneficiaries. Read more