Table 1.

Model Input Data and Sources

Parameter	Value	Source
Medicare payments
2019 Schedule estimate (reference) by CPT code*
99,201	$46.49	Centers for Medicare and Medicaid Services³ (based on relative value units listed in Table 125 of referenced rule)
99,202	$77.12
99,203	$109.20
99,204	$166.86
99,205	$210.83
99,211	$23.43
99,212	$46.13
99,213	$76.04
99,214	$110.28
99,215	$148.12
2021 Schedule estimate (updated rule) by CPT code*, including new primary care G code modifier (GPC1X)
99,201	$0 (to be discontinued)
99,202	$89.38
99,203	$128.30
99,204	$184.88
99,205	$233.53
99,211	$34.96
99,212	$60.55
99,213	$99.11
99,214	$133.34
99,215	$184.52
Medicare patients as a proportion of primary care patients, at practices accepting Medicare	31.3% (95% CI 4.9%, 66.7%)	National Ambulatory Medical Care Survey, details in⁴
Medicare patients as a proportion of primary care visits	24.7% (SD: 1.1)	National Ambulatory Medical Care Survey, details in⁴
Documentation time (hours/visit/day)		Prior time study⁶
During-visit	1.33 (SD: 0.86)
Outside of visit, during practice hours	0.52 (SD: 0.72)
Outside of practice hours	0.24 (SD: 0.73)
Visits/provider/day	12.3 (SD: 5.3)
Current fee-for-service payments to primary care, per full-time provider per year (all payers)	$638,634 (SD: $481,774; IQR: $378,463, $765092)	Medical Group Management Association, details in⁴

*Non-facility national average estimates are provided. Area-specific variations including work, practice expense, and malpractice geographic practice cost indices were taken accounted for in state-specific estimates (see Table 2). CPT: Current Procedural Terminology; 95% CI: 95% confidence intervals; SD: standard deviation; IQR: interquartile range