ACOG Win: CMS Increases Payment for Pelvic Exams

In the 2024 Medicare Physician Fee Schedule final rule, CMS listened to the ACOG community and took steps to help offset increased expenses facing obstetrician–gynecologists. The rule finalized a new add-on CPT code that provides additional funding that reflects the cost of pelvic examination packs and in-room chaperones.

The new CPT code reflects successful advocacy efforts from ACOG’s Health and Payment Policy team to make CMS aware of the additional resources required for obstetrician–gynecologists and other physicians who perform pelvic examinations during preventive and evaluation and management visits. Given the high number of pelvic exams performed each year in the United States, this increased funding will provide a sizable benefit to ACOG members. ACOG guidance indicates that pelvic examination should be performed when indicated by medical history or symptoms or as a result of shared decision making between the patient and their obstetrician–gynecologist or other gynecologic care professional.

For more detailed information about how to use the new code starting in the new year, see the article on the new CPT code, available through ACOG’s Payment Advocacy & Policy Portal. The article lays out the specifics of the add-on code, such as the respective CPT code sets that the new code must be used with and usage restrictions.

Keep an eye out for upcoming coding webinars providing more usage guidance and 2024 updates to ACOG’s Coding on Demand webinar series. ACOG’s coding resources are created to help members make the most of their coding. Members can always get personalized assistance through the Payment Advocacy & Policy Portal.