Medicare Increases Care Management Reimbursements

Medicare Increases Care Management Reimbursements

The 2022 Medicare Physician Fee Schedule proposes increasing reimbursement for services provided under Medicare’s Chronic Care Management (CCM) programs (and specialist care programs). These changes will affect common care management CPT codes and could significantly increase revenue for practices and health systems. Once the 2022 Physician Fee Schedule is finalized, practices and health systems can take advantage of these higher payments to improve their care management approaches.

Here is what practices and health systems need to know about these important changes to Medicare CCM reimbursement.

Medicare Proposes Increases of More Than 50% for Some Care Management Codes

Medicare launched the CCM program in 2015. This program pays practices and health systems to provide chronic care management services to patients between office visits. These payments total about $40 per member per month for 20 minutes of remote care management outside the office by, or on behalf of, physicians. The Centers for Medicare and Medicaid Services (CMS) designed the program to improve care for patients with chronic conditions and to lower health care costs.

While Medicare has added additional CPT codes over time, specific CCM code payment amounts have changed little since 2015. For many practices, these payments may be too low to support the development of new programs or to help high-risk patients manage their care.

But in the 2022 Medicare Physician Fee Schedule proposed rule, CMS proposes updating the Work Relative Value Units (wRVUs) for the CPT codes associated with CCM services. These updates will increase payments for chronic and principal care management for Medicare patients. For three CPT codes (99490, 99439, and G2065), the 2022 Medicare Physician Fee Schedule proposes significant payment increases relative to 2021:

  • Code 99490 will increase 54% relative to 2021. (CCM with clinical staff, first 20 minutes)
  • Code 99439 will increase 31% relative to 2021. (CCM with clinical staff, each additional 20 minutes)
  • Code G2065, becoming 99X24 will increase 63% relative to 2021. (Principal Care Management/PCM, for specialists, with clinical staff, first 30 minutes)

Payments for Remote Patient Monitoring (RPM), in contrast, will remain stable between 2021 and 2022.

What These Care Management Reimbursement Change Mean for Providers and Health Systems

Though Medicare introduced the CCM program in 2015, the use of these billing codes remains low. A recent survey found that while 77% of physicians were aware of the Medicare CCM program, only 12% billed for these services consistently. Also, for many practices, the current care management payments are too low to support robust programs. These payments do not account for the start-up costs for care management programs, which can be significant. Additionally, CCM payments may not cover the time physicians and other clinical professionals spend managing care for high-need patients.

The proposed 2022 payment increases for CCM services could help practices and health systems expand their care management programs. For example, these higher payments may allow larger practices to hire dedicated staff. Practices may also use the additional funds to devote more time to helping patients with chronic conditions manage their health.

The higher payments may also encourage more practices to implement care management approaches. Practices without the resources to run an in-house program can contract with services like CircleLink Health to get the financial benefits without the hassles and start-up costs.

The Value of Care Management to Medicare

In 2018, 68.9% of Medicare enrollees had two or more chronic conditions, according to CMS data. These patients have higher health care costs, more emergency department visits, and more hospital readmissions than those with fewer chronic conditions. Medicare introduced the CCM program to provide support for practices and health systems to manage care for enrollees with multiple chronic conditions between office visits. Since 2015, the CCM program has successfully improved health outcomes and lowered healthcare costs for these high-need patients.

Paying practices to provide or enhance care management keeps patients out of the hospital, saving Medicare money. An evaluation of the CCM program found it saved Medicare $28 per beneficiary per month at one year and $74 per beneficiary per month at 18 months post-implementation. The proposed updates to CCM payments show Medicare’s commitment to expanding this high-value program.

Provide Better Care Management with CircleLink Health

CircleLink Health combines intelligent software tools with care coaching by experienced RNs to transform care management for practices and health systems. A recent case study found that CircleLink’s Medicare CCM program reduced ER visits by 81% and hospital readmissions by 100% among high utilizers.

With CircleLink, practices can get all the financial and clinical benefits of care management without the technical and staffing hassles. And CircleLink’s software is user friendly and integrates seamlessly into existing workflows. Increase your Medicare reimbursements with CircleLink Health today.

For more information about CircleLink Health’s care management services, email sales@circlelinkhealth.com or call 209-890-8382.