Care Management Services Guidelines and CY2022 Proposed RVU ChangesPer the most current Federal Register CMS has proposed significant RVU/Fee increases for Chronic Care Management service (CCM) in CY 2022.

The following table shows the 5 CCM CPT codes with the proposed increase in RVU/Fees for CY 2022, followed by the current Care Management Service and Coding guidelines.

Many practices undervalue Care Management services that are already being rendered to their patients.

Review the service guidelines below to determine the eligible patient population, clinician and clinical staff responsibilities, as well as documentation requirements to track and prove compliance for billing these services.

Code Description 2022 Proposed Total RVU’s 2022 Proposed Fees 2021 Fees % Pro-Fee Increase (non-fac.)
99487 Complex chronic care; 1st 60 min (pm) 4.12 138.37 91.77 51%
99489 Complex chronic care; ea add’l 30 min (pm) 2.14 71.87 43.97 63%
99490 Chronic care mgmt. service 1st 20 min (pm) 1.89 63.48 41.17 54%
99439 Chronic care mgmt. service; ea add’l 20 min (pm) 1.47 49.37 37.68 31%
G0511 CCM/BHI by RHC/FQHC 20 min or more (pm) 2.44 81.95 65.25 26%

 

1. Care Management Service Guidelines:

  • Care management services are defined as the management and support services rendered by clinical staff under the supervision of a qualified clinician for patients living in a personal residence, domiciliary, rest home, or assisted living facility.
  • Some components of care management services include, but are not limited to, creating, implementing, altering, or monitoring a care plan; coordinating with other professionals and/or agencies; and providing education to the patient or caregiver on the patient’s medical condition, care plan, and prognosis.
  • The clinician is also responsible for the oversight of those services, as well as for the patient’s other medical conditions, psychosocial needs, and normal activities of daily living (ADL).
  • Typically, patients receiving this care have a minimum of two and possibly more chronic ongoing or episodic health conditions that are anticipated to last at least one year or until the patient expires and put the patient at increased risk of death, exacerbation, or functional decline.
  • Care plans address all of the patient’s health issues and are based on a thorough evaluation involving assessment of the patient’s physical, mental, cognitive, social, and functional health, as well as an environmental review, and are revised as necessary.
  • Codes may only be reported by the clinician who has the role of care manager with a particular patient for that one-month period.
  • Time spent face-to-face or non-face-to-face with clinical staff communicating with the patient, family, caregivers, other health care professionals, and agencies revising, documenting, and putting into action the care plan or teaching the patient self-management skills or techniques may be used to determine the care management staff time for that one-month time period.
  • Time with clinical staff is reported only when there are two or more staff members meeting regarding the specific patient. Additionally, time with clinical staff should not be counted if the clinician has reported an E/M service for that same date.
  • Generally, services provided by clinical staff involve such activities as ongoing review of the patient’s status, including reviewing laboratory or other test results that are not reported as part of an E/M service, evaluating whether the patient is following the treatment regime, and medication management.

2. Care Management Coding Tips:

  • These codes are used to report care management services provided by the clinical staff under the direction of a qualified health care professional to a patient residing at home, in an assisted living facility, domiciliary, or rest home.
  • These are time-based codes and total time spent performing care management services during the calendar month should be documented in the patient record.
  • If the physician provides face-to-face E/M visits in the same calendar month, these visits may be reported separately.
  • Do not count clinical staff time for a particular day if the physician reports an E/M service on that day.
  • These services may only be reported once per calendar month
  • Do not report these codes in addition to 90951-90970 for ESRD services or in the postoperative period of a reported surgery.

By: Sheila Haynes, CPC, Coding Program Manager

*References

**Disclaimer

  • CPT® codes are trademarked by the American Medical Association
  • CPT code descriptions in this article have been truncated to fit document formatting
  • All information and guidelines within the document were accurate based on the cited references as of 08/10/2021