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For instance, in cases where an investigation, settlement agreement, or judgement has determined inaccurate use of a higher paying code [523] that is reflected in payment amounts used in Shared Savings Program calculations, we may identify use of a code with lower reimbursement within a HCPCS or CPT code category that would result ( in a more precise adjustment to the ACO's payment determination

As described in the next section, we believe that this new proposed APCM code set could serve as a chassis to incorporate primary care model learnings over time under the PFS and an additional pathway to accountable care for primary care practitioners

of this proposed rule would have no impact on Medicare spending

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Care management is a resource-intensive process of working with patients, generally outside of face-to-face office visits, to help them understand and manage their health, navigate the health system, and meet their health goals