265.830 Capitation Carve Outs for High-Value Primary Care Services
MSSNY recognizes that care transition visits and preoperative consultation visits should not be included in global capitation budgets in primary care capitation payment models but should be paid on a fee for service basis carved out from the global capitation budget. Care transition visits and preoperative consultation visits should have unique CPT codes allowing those visits to be identified to insurers when such services are submitted for payment. MSSNY will actively support carving out both care transition and preoperative consultation visits from global primary care capitation rates, continuing fee for service payments at appropriate reimbursement levels for both of these services by educating physicians and insurers about this issue, and supporting and assisting efforts to make these adjustments in any capitation programs that have not already carved out these services. (HOD 2019-252)
