Coding & Reimbursement Resources

G2211 Add-On Code

Effective January 1, 2024 the Centers for Medicare and Medicaid Services implemented payment for G2211, a HCPCS add-on code to be billed in conjunction with an office/outpatient evaluation and management (E/M) code in certain instances. Learn more about how to use this resource and applications for physiatry.

Good Faith Estimates (GFE)

• CMS FAQs about Consolidated Appropriations Act , 2021 (CAA 2021) Implementation - Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals, Part 1
• CMS FAQs about Consolidated Appropriations Act , 2021 (CAA 2021) Implementation - Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals, Part 2
• CMS FAQS about CAA 2021 Implementation - Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals, Part 3
• CMS FAQs about CAA 2021 Implementation - Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals, Part 4 

AAPM&R Stroke Rehabilitation Toolkit

Stroke remains the second leading cause of death, the third leading cause of death and disability combined, and a leading cause of institutionalization in the world. Developed by the Academy’s Innovative Payment and Practice Models (IPPM) Committee, the Stroke Rehabilitation Toolkit is a clinical and educational resource that AAPM&R members, payers, and health care systems can utilize to develop care structures and alternative payment models (APMs) to allow for the provision of high value stroke rehabilitation care.

This toolkit offers members the tools they need to develop a physiatrist-led stroke rehabilitation APM, in which clinical outcomes and patient satisfaction will improve and costs will be reduced through consistent and direct involvement of physiatry in stroke rehabilitation care across the continuum.

Post-Acute Care (PAC) Toolkit

The Post-Acute Care (PAC) model is in the midst of an evolution. With today’s health care environment placing a greater emphasis on Value Based Purchasing (VBP), payors are examining both the quality and cost of care in PAC. As new payment models are being considered, recognizing the importance of patient oversight within PAC settings is critical.

The information provided in the Post-Acute Care (PAC) Toolkit aims to help you talk to your PAC administrators, fellow physicians, and other caregivers about your and your patients’ needs, and is based on Medicare regulations as Medicare is often the common guide for many payors.

The Physiatrist Articles

AAPM&R has developed a Coding & Reimbursement Tips column in the The Physiatrist to provide you with coding insights. These articles can be used as supportive coding data to appeal insurance denials, validate coding to auditors, train staff and answer day-to-day coding questions. Note: Accurate coding is the responsibility of the provider. These coding article are intended only as a resource to assist in the coding and billing process.

• 2025 MPFS and CPT Code Changes Impacting PM&R Practice (February 2025)
• 2024 Updates for Split/Shared Billing with Non-Physician Practitioners (September 2024)
• 2024 MPFS and CPT Code Changes Impacting PM&R Practice (February 2024)
• Medicare Policy Update - SI Joint Procedures (May 2023)
• Split/Shared Billing - What Physiatrists Need to Know When Sharing Visits with a Nurse Practitioner or Physician Assistant (March 2023)
• 2023 Medicare Physician Fee Schedule and CPT Code Changes Impacting PM&R Practice (February 2023)
• Inpatient and SNF E/M – What You Need to Know for 2023 (December 2022/January 2023)
• Medicare Physician Fee Schedule Payments: Unsustainable and At Risk (July 2022)
• 2022 Medicare Physician Fee Schedule and CPT Code Changes Impacting PM&R Practice (February 2022)
• Office and Outpatient E/M – What You Need to Know for 2021 (December 2020/January 2021)
• Coding for Imaging Guidance (April 2020)
• An Introductory Guide to Electrodiagnostic Billing - Part 3 (February 2020)
• An Introductory Guide to Electrodiagnostic Billing - Part 2 (October/November 2019)
• An Introductory Guide to Electrodiagnostic Billing - Part 1 (September 2019)
• Direct Prolonged Service Coding (August 2019)
• New Medicare Payments: Communication Technology-Based Services (May 2019)
• Earning a Seat for PM&R on the RUC (March 2019)
• MACs, RACs, etc.: Working with Medicare's Contractors (June 2018)
• Modifiers for Physiatry (May 2018)
• Urine Drug Testing: What You Need to Know (April 2018)
• RUC and the Code Valuation Process (Oct/Nov 2018)

Guide to Telehealth Under COVID-19

Click here to access the Guide to Telehealth.

Payer Denials

Members of the Reimbursement and Policy Review Committee (RPRC) and the Health Policy and Legislation Committee (HP&L) have been working for the past year to gather information and vocalize the Academy’s concern about payer denials to Congress and the Centers for Medicare and Medicaid Services (CMS). Learn more and find information to contact us if you have received a denial. 

Coding and Reimbursement Webinars

Throughout the year, AAPM&R sponsors webinars that focus on issues concerning the regulatory, federal, quality, and coding, and reimbursement issues directly related to physiatry.

Template Appeals Letter for Physicians Challenging Denials

Template Appeal Letter for Modifier 25

Medicare Resources

Learn more about Medicare and find resources to help your practice.