New Chronic Care Management (CCM), Complex Chronic Care Management, Principal Care Management (PCM), and Remote Patient Monitoring (RPM) Reimbursement Codes for 2022

CMS shows strong support for Chronic Care Management by increasing reimbursement and adding more codes in 2022

CMS released their 2022 Medicare Physician Fee Schedule Final Ruling last month and it has some really good news for Chronic Care Management, Complex Chronic Care Management, and Principal Care Management for the year 2022 while some not-so-good news for Remote Patient Monitoring reimbursement. Below is the overview of the codes that have been added as well as their national average rates as compared to 2021. As usual, make sure to check with your local geographic area adjustments, MAC’s and your billing department for guidance.

1: Expanded set of codes for chronic care management and increased reimbursement

CMS explanation of CCM is as follows:

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: 

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient 
• Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline 
• Comprehensive care plan established, implemented, revised, or monitored

Chronic Care Management reimbursement comparison 2021 vs 2022

2: Complex Chronic Care Management reimbursement

Complex Chronic Care Management includes everything from CCM + Moderate or highly complex decision making. It is interesting to note that if you spend 60 min of clinical staff time with a patient, you can either bill for 99487 or a combination of 1 unit of 99490 and 2 units of 99439. The former pays ~$130 while the later pays ~$156 so with a ~$26 difference, there is little reason to bill for Complex Chronic Care Management.

Complex Chronic Care Management reimbursement comparison 2021 vs 2022

3: Principal Care Management

A qualifying condition for Principal Care Management (PCM) services may be expected to last between three months to one year or until the death of the patient. The initiation of a PCM service will typically be triggered by an exacerbation of the patient’s chronic condition or recent hospitalization. The patient’s primary care physician will still supervise the patient’s overall care, but a specialist will manage services for the specific chronic condition.

This code is a great opportunity for specialists to manage their patient’s disease-specific condition(s) while removing the burden of managing additional chronic conditions the patients have that are not relevant to the physician’s specialty.

Principal Care Management reimbursement comparison 2021 vs 2022

4: Remote Patient Monitoring

Remote patient monitoring has seen explosive growth in adaption especially after the outbreak of Covid-19. VA is set to spend $1 billion to expand its roll-out of RPM. Unfortunately, CMS has decided to cut down the reimbursement of the device code 99454 by about 9$ in spite of stakeholders’ complaints that the original fee schedule was not enough to pay for these hi-tech devices. RPM can be a tricky roll-out and practices that have worked with companies like mTelehealth have benefitted tremendously from the deep experience of patient engagement and interactions.

Complex Chronic Care Management reimbursement comparison 2021 vs 2022