NEW 2021 Medicare Reimbursement Changes

After heroically navigating 2020’s COVID pandemic, healthcare providers must now decipher 2021’s whipsawing Medicare reimbursements for Chronic Care Management (CCM), Remote Patient Monitoring (RPM) and other preventive care.

Bottom line, 2021 reimbursements for CCM, RPM and related preventive care are now ~$1 lower per patient per month compared to last year.

What Happened

The confusion we’ve seen amongst our customers stems from a swift policy reversal late last year.

Medicare (CMS) initially finalized a 2021 physician fee cut of ~8% in November 2020. These initial fee reductions were required (under congressional budget neutrality mandates) to create a budget for planned increases to many primary care reimbursements. With these primary care fee boosts, CMS projected that primary care doctors would receive net overall Medicare reimbursement increases of ~10%.

But then a month later, on Dec. 28th, 2020, Medicare reversed course when H.R. 133 (The Consolidated Appropriations Act, 2021) was signed into law. The Act included language regarding the suspension of the payment adjustment.

What Changed

The 2021 fees for Chronic Care Management (CCM), Remote Patient Monitoring (RPM) and related preventive care reimbursements are now about $1 lower per patient per month compared to last year.

Of note, the collaborative care model (“CoCM” behavioral health integration) 2021 reimbursements are up about $8 per patient per month compared to 2020.

See the tables below for a more comprehensive summary of these 2021 reimbursement changes.

Chronic Care Management (CCM) / Remote Patient Monitoring (RPM) –  National Average
Code Description 2020 Non-Facility Fee 2021 Non-Facility Fee $ Change
99453 Rem mntr physiol param setup (RPM) $18.77 $19.19 $0.42
99454 Rem mntr physiol param dev (RPM) $62.44 $63.16 $0.72
99457 Rem physiol mntr 1st 20 min (RPM) $51.61 $50.94 -$0.66
99458 Rem physiol mntr ea addl 20 (RPM) $42.22 $41.17 -$1.05
99490 Chrnc care mgmt svc 1st 20 (CCM) $42.22 $41.17 -$1.05
G0511 Ccm/bhi by rhc/fqhc 20min mo (CCM) $66.77 $65.25 -$1.52
99439 Chrnc care mgmt svc ea addl 20 mins (CCM) $37.89 $37.68 -$0.21
99484 Care mgmt svc bhvl hlth cond (CCM) $48.00 $46.76 -$1.24
G2065 Clin mang h risk dx 30 (CCM) $39.70 $38.73 -$0.97
G2064 Md mang high risk dx 30 (CCM) $92.03 $90.37 -$1.66
AVERAGE: -$0.72
MEDIAN: -$1.01

 

Behavioral Health Integration: Collaborative Care Model – National Average
Code Description 2020 Non-Facility Fee 2021 Non-Facility Fee $ Change
G0512 Cocm by rhc/fqhc 60 min mo $141.83 $154.23 $12.40
99492 1st psyc collab care mgmt $156.99 $154.23 -$2.76
99493 Sbsq psyc collab care mgmt $126.31 $154.23 $27.91
99494 sbsq psyc collab care (add’l 30 jmins) $63.88 $58.97 -$4.91
AVERAGE: $8.16
MEDIAN: $4.82

 

Source: Retained Medicare/CPT Experts

Note that services under CPT G2058 are now billable under CPT 99439. CPT 99439 covers CCM  services rendered for additional 20 minute periods following the initial 20 minutes of CCM services rendered under CPT 99490. 

What to Do

The physician fee cut suspension is not going anywhere anytime soon . Our experts see that this suspension will be in effect for at least the duration of 2021. And once you factor in the new Biden administration, it’s likely to continue through 2022. Thus, understanding and adjusting to these new reimbursements is imperative.

Is your practice equipped to handle the changing waters and complexities of CCM/RPM? If not, CircleLink is here to help. Our medicare experts are ready and willing to advise on any reimbursement issues. The combination of intelligent software tools and experienced, 100% RN care coaching means better profitability, better billing compliance, and better healthcare outcomes.

For more information about our services, email sales@circlelinkhealth.com or call 917-999-6560.