Professional medical billing services stay on top of the latest coding changes put forth by the federal authorities to ensure that they deliver the best possible outcome to their clients. Keeping that in mind, chronic care management has taken up a special place in Medicare’s latest announcement regarding its billing rates and coding practices which the professionals need to know. In an unexpected turn of events, the CMS has increased the payment rates for chronic care management while accommodating new and edited codes to implement the new practices.

Several healthcare leaders believe that CMS is favoring the practice of chronic care management since it is a service that aligns with the goals of the CMS in patient care programs. The chronic care management services generate high revenue and, at the same time, provide value to the patients. It is why CMS has become more inclined toward boosting this service. While the new and edited codes come to play in the field, professionals in medical billing services must study the latest updates and get the best results.

Increase in Payment Rates

The CMS has increased the payment rates for 10 CPT codes for chronic care management, leading to greater reimbursements for the clients of medical billing services. However, professionals need to be careful regarding using these codes since they come with separate clauses.

Chronic Care Management: 4 Codes

According to CMS, Chronic Care Management can be categorized as such if the following is true regarding the condition of the patient:

  • The patient must have two or more chronic illnesses that can be expected to last for a minimum of 12 months up to their death.
  • The chronic condition affects the patient in a way that might lead to death or functional decline.
  • A summary of the care plan must be in place that is regularly checked and edited if necessary.

The professionals at the medical billing services can only implement the CPT codes if the healthcare provider dedicates at least 20 minutes of their time in a particular calendar month for their patient..

The codes with increased payment rates in CCM are:

  • 99490: 20 min Clinical Staff CCM- national allowed amount rose from $41.17 in 2021 to $62.16 in 2022.
  • 99439: Additional 20 min Clinical Staff CCM- national allowed amount increased from $37.69 in 2021 to $47.04 in 2022.
  • 99491: 30 min, Physician and NP CCM- national allowed amount rose from $82.53 in 2021 to $83.66 in 2022.
  • 99437: Additional 30 min, Physician and NP CCM- It is a new code. The national allowed amount was launched at $59.47 for 2022.

Complex Chronic Care Management: 2 codes

The complex chronic care management should also follow all the clauses of chronic care management to be categorized as such. Additionally, CCCM needs an element of moderate or highly complex decision-making.

The codes with increased payment rates in CCCM are:

  • 99487: 60 min, Clinical Staff CCCM- national allowed amount rose from $91.77 in 2021 to $130.37 in 2022.
  • 99489: Additional 30 min, Clinical Staff CCCM- national allowed amount increased from $43.97 in 2021 to $68.51 in 2022.

Principal Care Management: 4 codes

Principal care management, one of the closest services similar to CCM, has also seen particular changes that medical billing services should be aware of implementing. According to the CMS, the services must have the following elements to qualify for PCM:

  • The PCM service usually comes into play after the patient’s recent hospitalization or the acute worsening of their existing chronic condition.
  • The condition should continue for at least three months to a year or till the patient’s death.
  • The PCM plan allows the primary care physician to take overall care of the patient while the specialty physician can look over the relevant chronic condition.

Not all codes in PCM have undergone an increase. Two of the codes have been added, while two have suffered payment changes.

  • 99424: 30 min, Physician/NPP, PCM- the national allowed amount has decreased from $90.37 in 2021 to $80.95 in 2022.
  • 99425: Additional 30 min, Physician/NPP, PCM- It is a new code. The national allowed amount was launched at $58.46.
  • 99426: 30 min, Clinical Staff, PCM- national allowed amount increased from $38.73 in 2021 to $61.49 in 2022.
  • 99427: Additional 30 min, Clinical Staff, PCM- It is a new code. The national allowed amount was launched at $47.04.

New Codes Added

The CMS has decided to focus on providing more coverage for five new CPT codes to ensure excellent benefits for the chronic care management and principal care management processes. Here are the new codes that the professionals of the medical billing services should know:

  • 99X21: CCM for every additional 30 minutes apart from the primary procedure by a physician or qualified healthcare provider in every calendar month.
  • 99X22: PCM for the first 30 minutes in case of a single high-risk disease personally by a physician or other qualified healthcare provider every calendar month.
  • 99X23: PCM for each additional 30 minutes apart from the primary procedure in case of a single high-risk disease personally by a physician or other qualified healthcare provider every calendar month.
  • 99X24: PCM for the first 30 minutes in case of a single high-risk disease by the clinical staff as directed by the physician or other qualified healthcare provider every calendar month.
  • 99X25: PCM for each additional 30 minutes apart from the primary procedure in case of a single high-risk disease by the clinical staff as directed by the physician or other qualified healthcare provider every calendar month.

Why are these changes important for medical billing services?

It is evident from the changes put forth by CMS that the authoritative agency is looking forward to boosting the Chronic Care Management family of services. The healthcare leaders feel that it is because CCM can ensure a better quality of life for the patients, thus ensuring a better healthcare landscape for the American medical industry. The increase in physician payments will help maintain a good balance of care and revenue. Correct and accurate billing of CCM services, when done by the professional medical billing services, will actualize the goal.

Frequent staff training is vital for the medical billing services to stay ahead of the curve in revenue inflow. Ensure that your staff is adept at incorporating these new changes into your daily workflow to get the best outcomes for your clients.

We hope this article helped you understand the new changes in the chronic care management codes and how you should use them in medical billing services. Please connect with us in the comment section below in case of any queries. Subscribe to our blog for regular articles on the medical billing industry. Follow us on Facebook, Instagram, Twitter, and LinkedIn for more.