CMS Develops New Billing Codes for Chronic Care Management Services

The 2014 final rule for the Medicare physician fee schedule included the addition of a new payment code for chronic care management to begin in 2015. The new code will allow reimbursement for non-face to face time physicians spend managing patients with multiple chronic conditions that are not reimbursed under the current Evaluation and Management codes physicians bill for office visits. These codes are in addition to the recently added Transition Care Management codes (TCM 99495-99496), which also reimburses physicians for non-face to face time association with transitioning patients to the community.

In the final rule, the Centers for Medicare& Medicaid Service (CMS) agreed to assign only one code for chronic care management services rather than two separate codes, and shorten the time frame for providing the service from 60 minutes per 90 days to 20 minutes per 30 days. The new code will read as follows:

“Chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”

The final rule sets the scope for chronic care management services to include:

  • 24-hour-a-day, 7-day- a-week access to address a patient’s acute chronic care needs.
  • Continuity of care with a designated practitioner or member of the care team with whom the patient is able to get successive routine appointments.
  • Care management for chronic conditions including systematic assessment and development of a patient centered plan of care.
  • Management of care transitions within health care.
  • Coordination with home and community based clinical service providers.
  • Enhanced opportunities for a patient to communicate with the provider through telephone and secure messaging, internet or other asynchronous non face-to-face consultation methods.

CMS accepted comments on the following proposed standards that it expects physicians to comply with in order to furnish and receive reimbursement for chronic care management services:

  • The practice must be using a certified Electronic Health Record (EHR).
  • The practice must employ one or more advanced practice registered nurses or physician’s assistants.
  • The practice must be able to demonstrate the use of written protocols by staff participating in the furnishing of services.
  • All practitioners involved in the furnishing of chronic care management services must have access at the time of service to the beneficiary’s EHR.

CMS intends to issue its final standards in the 2015 Physician Fee Schedule rule.

CMS was clear in the final rule that the TCM service codes and the Care Plan Oversight codes for home health and hospice (G181- G0182)  may not also be billed during the time period when Chronic Care Management services are billed.

To view the final rule, please click here.

Source: NAHC

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