MEDICARE REIMBURSEMENT FOR GERIATRIC ASSESSMENT - REPORT OF THE AMERICAN-GERIATRICS-SOCIETY AD HOC COMMITTEE ON GERIATRICS ASSESSMENT

This ad hoc committee report from the American Geriatrics Society proposes the prompt initiation of Medicare reimbursement for geriatric assessment (GA) services (also termed comprehensive geriatric assessment or geriatric evaluation and management services). Despite an extensive body of literature documenting the effectiveness of GA for improving health care outcomes in many settings for identifiable groups of frail elderly patients, no explicit Medicare reimbursement mechanisms currently exist to cover GA services provided by either hospital or physician. We believe that new physician reimbursement codes specific for geriatric assessment should be established in the Current Procedural Technology (CPT-4) manual and that reimbursement for GA should be specifically provided under Part B of Medicare. Further, we believe that hospital reimbursement within the Medicare prospective payment system should be modified to encourage GA during inpatient stays for appropriate patients. This paper summarizes the background for these recommendations. It defines the major content of GA at three levels of intensity-screening, intermediate, and comprehensive. It describes the major sites for conducting GA-hospital, office, home, nursing home. Finally, it proposes criteria for targeting patients most likely to benefit from GA.