As a solo employed infectious diseases physician in a small health system serving Horry and Georgetown counties in South Carolina, I have seen firsthand how our specialty is both essential and undervalued. After a decade in private group practice and two years in academic research post-fellowship, I transitioned to this semi-urban setting seeking stability and a renewed sense of purpose. What I have found is a community in need — and a health care system that still struggles to recognize the full value of what we do.
ID physicians manage far more than antibiotic prescriptions. We handle complex, nuanced cases that require time, precision and deep clinical insight. We coordinate with hospitalists, pharmacists, surgeons, nurses, microbiologists, case managers and social workers, among others. We track down lab results, interpret obscure cultures and often serve as the final stop in diagnostic dilemmas. Yet, the billing system rarely reflects the cognitive and collaborative intensity of our work.
G0545: A first step and a foothold
The introduction of billing code G0545 by the Centers for Medicare & Medicaid Services in 2024 was a long-overdue step toward acknowledging the complexity of ID care. It is the first code specifically designed for our specialty, and while it brings hope, it also introduces new challenges. Each insurer has different policies, and Medicare closely monitors its use. Even when used appropriately, payment is not guaranteed. The modest 0.89 work RVUs attached to the code fall short of capturing the time and expertise required to manage the cases we see daily.
Historically, ID has lacked a high-revenue procedure or intervention that is uniquely ours. The elimination of consult codes further eroded our visibility and financial footing. G0545 offers a symbolic and practical foothold, but it is still tied to an arbitrary valuation. It doesn’t guarantee improved competitiveness in a health care market that often rewards volume and procedures over thoughtfulness and prevention.
Our impact — on patient outcomes, hospital length of stay, antimicrobial resistance and public health — is difficult to quantify and often falls outside traditional metrics. Yet, we are indispensable. We must advocate for a physician compensation framework that reflects the true scope and value of our work. Facility fees, value-based contracts and market dynamics continue to shape how we are paid. G0545 is uniquely ours, and we must use it strategically — not just to bill, but to assert our role and worth.
This advocacy must begin locally. In my own practice, I have used G0545 to highlight the depth of ID care. I have had to call microbiology labs to preserve isolates for susceptibility testing, coordinate with multiple physicians across systems and piece together fragmented care histories — often outside of billable time.
These efforts are invisible in most compensation models, but they are the essence of what we do. I now apply this code to all inpatient Medicare visits and receive appropriate credit for the work it represents. I do not use it with telemedicine or other insurers. I do include a brief attestation statement in my progress note, not as a requirement for the code, but to remind myself to bill for it since the activities I performed support its use.
There are other encouraging signs. The Joint Commission now mandates antimicrobial stewardship programs, and hospitals are incentivized to reduce hospital-acquired infections. These changes create opportunities for ID physicians to lead.
However, we still face disparities compared to other fields. ID has not received the same telehealth carve-outs granted to mental health, despite the clear benefits of virtual care in managing infections and follow-ups. Much of the work we do for outpatient parenteral antimicrobial therapy remains uncompensated. Private insurers and Medicaid often do not reimburse for the outpatient code we commonly use (G2211), and there is uncertainty as to whether they will recognize or pay for G0545 either. This signals a broader issue: Our specialty is still not prioritized in policy or payment reform.
How to move forward
We cannot continue to operate as if we are doing charity work. We must insist on commensurate compensation — not just for ourselves, but to ensure the sustainability of our field. A 2020 study showed that over 80% of U.S. counties lack an ID physician. If we want to attract new talent, we must create a viable, rewarding path forward.
Those of us with institutional support or more flexible practice environments must advocate on behalf of our colleagues in underserved areas. The solo ID physician in a rural or semi-urban setting — like me — must be able to thrive on standard insurance payments. G0545 should be used not only for billing but as leverage in negotiating contracts for infection prevention, antimicrobial stewardship and epidemiology.
We cannot build sustainable practices on antibiotic infusion revenue or the occasional high-paying contract. The real test is whether an ID physician can survive and succeed based on the merit of their clinical work. That’s the benchmark we must fight for.
We can begin by collecting and sharing data on how G0545 affects our workload, compensation and perceived value. This information can help demonstrate our impact to hospitals, insurers and policymakers. It is essential to show that ID physicians are not interchangeable with other physicians or practitioners — that our training, judgment and ethical commitment to patient care are irreplaceable.
Infections are complex. Their treatment requires not just knowledge, but wisdom, collaboration and relentless attention to detail. This is not something that can be replaced by algorithms or protocols. It deserves recognition — and meaningful compensation.
G0545 should not be treated as just another billing code. Let us treat it as a rallying point — a signal that the time has come to redefine how ID care is valued in American health care. Together, we can lead that change.
Visit IDSA’s Coding and Payment webpage for more information about how to use the G0545 add-on code, including Q&As, a webinar recording, an infographic checklist and more.
The Coding Corner updates IDSA members about coding and billing issues. If you would like to ask a question for the Coding Corner, or if you have a general coding and billing question, please visit the Coding and Payment page and click on the yellow “Ask the Coder” button at the bottom of the page (member login required to submit a question).