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
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