November 2021 Update 

 

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule Final Rule. The biggest takeaways impacting Medsien clients are that care management services are here to stay – CMS has significantly increased the reimbursement and added additional codes and categories within care management services. They have expanded the code set for care management to include Chronic Care Management (CCM) and Complex Chronic Care Management (CCCM), and updated codes for Principal Care Management (PCM) services.

 

Also, effective January 1, 2022, CMS has introduced a new category of digital health services – Remote Therapeutic Monitoring (RTM) – to complement the existing suite of Remote Patient Monitoring (RPM) codes covered under Medicare.  The new codes are intended to expand the scope and reach of digital health technologies to reimburse monitoring of non-physiologic data. The new RTM codes broaden Medicare reimbursement for remote monitoring beyond the existing Remote Physiologic Monitoring (RPM) codes and represent one of the latest advancements to modernize reimbursement for digital health. The RTM family includes three practice expense (PE)-only codes and two codes that include professional work. Medsien is excited to be expanding our services into RTM programs. Look for more information in early 2022.  

 

Additional codes and new reimbursement for these RTM services have been added. And CMS’ new rates for remote patient monitoring (RPM) have been announced as well. Another interesting trend to note is that both PCM and RTM services apply more to specialty providers, showing that Medicare is moving into reimbursement and support for a broader range of providers. 

 

CMS is clearly invested in the clinical and financial benefits of care management services for the coming year and going forward. There’s no better time to add care management programs to your practice. Or, to maximize the benefits and efficiency of your existing care management programs by improving the quality and efficiency of your program.  

 

We will outline expected changes impacting codes related to Medsien’s services for 2022 below, and will follow up in early 2022 with an update when final changes for the year go into effect. 





Care Management Code Set – Update

 

Code

Same/New

Code Info

2021 Rate

2022 Rate 

CCM

       

99490

same

Initial 20 min

$42

$62 (+$21.00)

99439                                                                         

same

Next 20 min  (x2)

$38

$47 (+$9.35)

99491

same

Subs 30 min, physician or NPP 

$82.53

$83.66 (+1.13)

Complex CCM*

       

99487

same

1st 60 min 

$92

$130 (+37.00)

99489

same

Next 30 min

$44

$69 (+$25.00)

Principal Care Management (PCM):    

       

99426

(Prev G2065)

Initial 30 min, clinical staff 

$39

$61.49 (+$23)

99427

new

Subs 30 min, clinical staff   

n/a

$47

99424

(Prev G2064)

Initial 30 min, physician or NPP 

$90

$81 ($9.39)

99425

new

Subs 30 min, physician or NPP   

n/a

$58.46

 

*CMS likely phasing out because there’s little financial difference with general CCM and more requirements of CCCM

 

Remote Monitoring: 

 

Code

Same/New

Code Info

2021 Rate

2022 Rate 

Remote Therapeutic Monitoring (RTM):

NEW!

     

98975

new

Service initiation   

 

$18.82

98976

new

Monthly data transmission – respiratory system  

 

$54.10

98977

new

Monthly data transmission – musculoskel system 

 

$54.10

98980

new

Treatment mngmt svcs, clinical staff, in 20 min   

 

$48.72

98981

new

Treatment mngmt svcs, clinical staff, add 20 min   

 

$39.65

Remote Physiologic Monitoring (RPM):     

       

99453

same

Service initiation

$20

$18.48 (-$0.71)

99454

same

Monthly data transmission   

$64

$54 (-$9.06)

99091

same

30 min, data analysis & interp 

$57

$55 (-$2.11)

99457

same

Initial 20 tx mngmt scvs         

$51

$49 (-$2.22)

99458

same

Ea addtl 20 tx mngmt svcs  

$42

$40 (-$1.52)

 

 

Ongoing trend – Medicare committed to the growth of care management 

 

This continuous trend of CMS investment in care management is likely to continue.  Each year since CMS initially added reimbursement for care management in 2015, they’ve continued to triple down on it, showing a clear interest and belief in the value of care management for patients. Annually adding new codes, increasing reimbursement and easing requirements  – clearly shows the trend towards more and more investment and commitment to these programs.

 

The bottom line is that this is a good time for care management in general, and for practices that have already adopted good care management programs. But it’s really the perfect time to add a robust care management program to your practice. Medsien’s top of the line, turn-key, highly sophisticated care management programs are fast and easy to implement and run, require no administrative or staffing burden nor any upfront costs to the practice. For more information on our programs and services, visit www.medsien.com

 

                 

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