What’s New with CCM? Medicare Reimbursement 2020 Code Changes Explained!

First, let’s have a quick look at what were the codes in 2019.

Beginning January 1, 2019, the CCM codes were as below

CPT 99490 (Non-complex)

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.

CPT 99491

Chronic care management services, provided personally by a physician or nurse practitioner for at least 30 minutes, per calendar month to high-risk patients. Codes 99490 and 99491 cannot be billed in the same month for the same patient so practices will need to decide if this new code is a good use of their doctors’ time and which patients would benefit from it.

CPT 99487 (Complex)

 Complex chronic care management services, with at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 (Add-on for CPT 99487)

Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for primary procedure).

Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes in addition to the first 60 minutes of complex CCM services during a calendar month.

The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex CCM during a given service period, not both. Do not report 99491 in the same calendar month as 99487, 99489, 99490.

What’s New?

On Nov 15, 2019, Centers for Medicare and Medicaid Services (CMS) finalized the CY 2020 Medicare Fee Schedule (MFS). It has revised the current chronic care management reimbursement program and has created a new care management reimbursement program.

Here’s a quick look at 2020 Medicare Reimbursement Codes for Chronic Care Management:

99487, 99489*, 99490, G2058*, 99491

CMS has created an add-on code, HCPCS Code G2058 for non-complex CCM effective Jan 01, 2020.

G2058 Specifications:

A medical practitioner can bill CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM activities (educating the patient or caregiver about the patient’s condition, care plan, and prognosis, etc.) in a given calendar month and can charge HCPCS code G2058 for the second and third 20-minute additions (additional staff time respectively). Use G2058 in conjunction with 99490. Do not report 99490, G2058 in the same calendar month as 99487, 99489, 99491. These CPT codes are tailored toward primary care physicians but can be billed by any physician or by any skilled healthcare professional and get the reimbursement by fulfilling the code requirements.

Payment or reimbursement for the CPT code 99490 is $42.23 while the add-on code G2058 (up to two) pays $37.89. Therefore, total reimbursement for an hour or more of non-complex CCM services is $118.01.  

** Add-on codes are bundled and cannot be billed separately from their base code.

CCM Patient Eligibility

Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services.

How does the scope for CCM look like in 2020?

Qualified healthcare professionals have been billing Medicare for providing CCM services like maintaining care plans, handling care transitions between providers to Medicare patients with two or more chronic conditions. Even today CCM continues to be underused.

The epidemic of chronic disease continues to grow and has reached global epidemic proportions. This condition is exerting considerable demand for health systems to adopt an IT solution to provide better care for their chronic patients. This increased demand has become a major concern today. Adapting new technology or operating models is vital for the health systems to provide care differently, more efficiently, and with better patient outcomes.

HealthViewX CCM platform helps individual physicians, practices, billing companies, etc. to provide CCM services seamlessly to their enrolled Medicare patients. The simplified and automated process makes it easy to meet the criteria for CMS billing and reimbursement.

Power your entire system – simplify your workflow, create patient-specific care plans, automate documentation, generate detailed reports, and improve overall efficiency. Hosted in cloud servers, HealthViewX CCM solution is extremely scalable to meet requirements of any operative size and our pricing model keeps overhead cost minimal and manageable.

Schedule a demo and talk to our solution experts today!

Ref: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

https://hcpcs.codes/g-codes/G2058/