Chronic Care Management: Medicare Goes All In

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Chronic Care Management: Medicare Goes All In
by Lucy Lamboley

If you read our previous post about the love affair between chronic care management and Medicare, then you already have a pretty good idea of how invested the Centers for Medicare & Medicaid Services (CMS) is in the provision of chronic care management (CCM) services. But what does this really mean for you and your patients, and why should you leverage this bonded relationship for the benefit of your organization?

The Goals for Chronic Care Management and Medicare Patients

The support provided by CMS to chronic care management is making waves, and rightfully so. After all, recent decisions demonstrate the federal agency's desire to see more care delivered via CCM. In 2022, CMS finalized updates for the values of the 10 chronic care management billing codes within the CCM family, which will make providing this valuable service to your patients even more worthwhile. CMS is declaring its intended investment in the future of CCM, indicating the agency views the services as an integral component of its overall long-term patient care strategy. Want further proof? CMS publicly declared that CCM is "consistent with our goals of ensuring continued and consistent access to these crucial care management services and acknowledges our longstanding concern about undervaluation of care management under the physician fee schedule."

Now that CMS has made it known it plans on supporting these services for the long haul, what exactly does the agency expect of participating physicians and their Medicare patients? CMS seems to be seeking productive patient and provider relationships where the patient's true chronic disease risk(s) is being mitigated. CMS understands that patient engagement is vital to patient health, and patient interactions should be meaningful and productive.

Physicians and organizations developing and participating in CMS chronic care management programs should be providing their patients with comprehensive care management that leads to overall better health and improved health outcomes. As this Medical Economics column notes, a comprehensive care management program combines the likes of chronic care management with remote patient monitoring (RPM), behavioral health integration (BHI), and other services to better provide patients with timelier, more personalized, and highly efficient remote care.

Low Down on Chronic Care Management Reimbursement

To seemingly encourage greater adoption and delivery of CCM services, CMS has increased reimbursements on several chronic care management billing codes. The most notable CCM reimbursement increase concerns base CPT code 99490, which covers the first 20 minutes of clinical staff time. The reimbursement on this code has been significantly increased in 2022, up from $41.17 to $64.03, adding nearly $23 per incidence. Furthermore, each additional increment of 20 minutes of CCM clinical staff time (covered under CPT code 99439) has also been bumped from $37.69 to $48.45, increasing each billing instance by nearly $11.

To add some icing to the cake, the complex chronic care management billing codes — CPT 99487 and CPT 99489 — both received a significant jump in value, making the underutilized service a more attractive potential offering for organizations. The first 60 minutes of complex CCM will pay out at $134.29, increasing by more than $42, and each additional 30 minutes have increased by nearly $27 to $70.60 per each additional 30 minutes of complex CCM time.

These chronic care management reimbursement increases make CCM services even more lucrative for organizations. While deciphering the intent and purposes of Medicare is never easy, it certainly seems like the agency is trying to dangle the proverbial carrot with the purpose of encouraging the increasing use and participation in CCM programs by Medicare practitioners and their patients.

CMS Loves Me … and a Little CMS Loves Me Not

While CMS has significantly increased reimbursements for the time spent on chronic care management services, 2022 also brought a small but material decrease to the complementary service of remote patient monitoring. While no care management RPM codes were targeted for a reduction, CPT 99454, which covers the monthly remote transmission of physiologic measurements, was reduced by about 11%.

RPM remains a viable and valuable service to provide to patients, but the decrease should further motivate organizations to explore creating and implementing a comprehensive care management program that utilizes the CCM codes for management time and the RPM codes for device readings. Why? The use of RPM technology can undoubtedly reduce costs and improve care, but such solutions are best supported by personal interactions between practitioners and patients that use the structure of CCM. This sentiment seems to be reinforced with the RPM device-only payment decrease and the CCM payment increases. It appears CMS is discouraging the use of remote patient monitoring devices alone and encouraging a more jointed, hands-on approach. In other words: comprehensive care management.

Other Care Management Opportunities To Know

As you begin to explore where chronic care management fits within your organization, here are some other key developments to understand:

  • Base code and add-on codes: Chronic care management — as well as principal care management (PCM) — codes now include a base code and an add-on code, better ensuring all physician or qualified healthcare provider time can be accounted for and properly reimbursed. This means that CCM has become one of the most useful programs, both financially and for care provision, that Medicare offers.
  • Transitional care management: Rural health centers (RHC) and federally qualified health centers (FQHC) can now concurrently bill for chronic care management and transitional care management services. This shows CMS is acutely aware that rural patients need broader and more convenient access to healthcare, especially where there might not be many or any other options. This is also why we're increasingly seeing rural hospitals with remote patient monitoring programs.
  • Remote therapeutic monitoring: While remote therapeutic monitoring (RTM) remains a newer concept, its codes are worth watching closely. In a nutshell, remote therapeutic monitoring is intended for the management and collection of non-physiological data via patient utilized medical devices. Currently, CMS projects that the primary biller of RTM will be physical therapists, physician assistants, and other allied professionals like clinical social workers.

Medicare Going All in for CCM Is a Win for Everyone

So, what's the takeaway from all these developments concerning chronic care management and care management services more broadly? Aside from the fact that CCM is good for patients, we can conclude that it's also excellent for organizations and payers like CMS. The federal agency is showing all indications that it plans keep its fingers in the CCM game for the long haul. CMS has thrown its weight — and money — behind CCM as it recognizes the value of physicians and their care teams providing ongoing support to help patients achieve goals and reduce the need for healthcare services.

CMS's growing support for chronic care management, particularly when included in a broader comprehensive care management program, makes it the perfect time for organizations to develop and grow very effective programs. CCM leaves patients feeling better connected to their care teams and strengthens care coordination overall. It also greatly reduces the need for emergency care, saving patients and our healthcare system significant dollars every year.

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