HCPCS Codes G9037 & G9038: A Game-Changer for Primary Care Providers

Clinicians in the Making Care Primary (MCP) model can now bill for interprofessional consultations using HCPCS Codes G9037 & G9038. Introduced in FY 2024, these codes enable primary care providers (PCPs) to coordinate care with specialists, improving patient outcomes. G9037 covers electronic consultations, while G9038 supports ambulatory co-management. Available in eight states, the MCP model promotes value-based care with benefits like higher Medicare conversion factors and MIPS exemptions. Proper use of these codes helps streamline communication, reduce care gaps, and ensure adequate reimbursement for providers. Understanding the billing conditions for each code is crucial to maximizing revenue and compliance. These new HCPCS Level II codes align with Medicare’s shift toward quality-based payment models, reinforcing the importance of care coordination in accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Learn how these updates impact your practice and improve healthcare efficiency.