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Boston, MA – A new analysis by researchers from the Harvard Pilgrim Health Care Institute examines the first Centers for Medicare and Medicaid Services (CMS) add-on code targeting a single physician specialty: infectious disease (ID). The measure is a significant departure from the agency’s past strategies, with the potential to combat the growing shortage of ID physicians and broader implications for physician reimbursement and healthcare delivery, according to the authors.
The Viewpoint, “Raising Reimbursement Rates to Combat Specialty Physician Shortages: A New Federal Initiative” was published on June 25 in JAMA .
Despite the vital role ID doctors play in critical public health functions such as pandemic preparedness and antimicrobial stewardship, they are among the lowest paid of all medical specialists. This imbalance between expertise and pay has contributed to a declining interest in the field, leaving half of ID fellowship positions unfilled in 2024. As a result, the U.S. faces a growing shortage of ID physicians, with an uneven distribution that disproportionately affects vulnerable and rural populations.
In response to ID physician discontent, the 2025 Medicare Physician Payment Final Rule included a new add-on code (G0545) for inpatient ID consultations, increasing reimbursement by $28.80 per inpatient ID consultation, an increase of approximately 20% on average over prior compensation levels. The services eligible for the add-on code include disease transmission risk mitigation, public health investigation, analysis and testing, and complex antimicrobial counseling and treatment.
“Infectious disease physicians are at the frontlines managing COVID-19 as well as future pandemics, yet their compensation is within the lowest quartile of all physician compensation,” said lead author Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. “The add-on code is a meaningful recognition that ID physicians are under-compensated relative to the complexity and intensity of their work, but it remains to be seen whether it will improve ID physician salaries and workforce.”
The authors emphasize that, compared to other physician-shortage incentive payment programs, the new ID add-on code does not have a time limit, offers a higher reimbursement increase, and is specialty-specific. They note that while this novel strategy put forth by CMS appears promising, additional steps should be considered while implementing and evaluating the new code. They make three recommendations:
The authors note that Medicare’s outsized influence on commercial payer fee setting means that the new add-on code has the potential to reset national benchmarks for ID compensation if done effectively. “Medicare is sending a strong signal that Infectious Disease expertise is worth more than our current payment system recognizes,” noted Tarun Ramesh, senior author of the study and research fellow at the Harvard Pilgrim Health Care Institute. He adds, “But if hospitals do not pass the bonus through to physicians, shortages in this specialty will continue to adversely affect patient care access and health outcomes.”
About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky , X , and LinkedIn .
JAMA
Raising Reimbursement Rates to Combat Specialty Physician Shortages A New Federal Initiative
25-Jun-2025