Insights

Why 2022 Chronic Care Management Fee Increases Could Foster Adoption Gains for Successful Programs

Since 2016 Chronic Care Management has remained one of the best-kept secrets in healthcare. But proposed increases to CCM reimbursements for 2022 have the Centers for Medicare and Medicaid Services (CMS) poised to encourage much-needed rises in adoption. 

That’s because, after six years, fewer than 10% of the 35-million Americans with multiple chronic conditions are benefitting from these services.

This is a pressing challenge for healthcare overall. More than two-thirds of Medicare beneficiaries with two or more chronic illnesses qualify for CCM services.

Evidence shows low use among patients and providers despite quantifiable effectiveness.

CMS officials wrote in the 2020 Fee Schedule, “(CCM has resulted in) increasing patient and practitioner satisfaction, saving costs, and enabling solo practitioners to remain in independent practice.” CCM has been shown to decrease hospitalizations, emergency room visits, and readmission rates while increasing providers’ revenue and reducing overall healthcare costs.

Further, evidence of success dates back to 2015, when CMS first compensated providers for coordinating CCM for Medicare beneficiaries.  In its inaugural year, around 8,000 physicians and non-physician practitioners billed approximately 1 million CCM services (CPT 99490) for about 320,000 Medicare beneficiaries.

An analysis of CCM’s impact on Medicare spending showed that expenditure decreased by $74 per CCM beneficiary per month after about one and a half years.

By 2018, the most recent Medicare utilization data available, more than 22,500 physicians and non-physician practitioners billed over 4 million CCM services, for 1 million Medicare beneficiaries.

To increase the rate of adoption, CMS has proposed:

==> Significant increases in reimbursement fees for the 10 chronic care management CPT codes. “(It is) consistent with our goals of ensuring continued and consistent access to these crucial care management services and acknowledges our longstanding concern about undervaluation of care management under the physician fee schedule."

==> 30% payment increase in 2022 for services corresponding with CPT Code 99490—requiring a minimum of 20 minutes a month of CCM care by clinical staff supervised by a physician.

==> CCM reimbursement for a Rural Health Clinic or Federally Qualified Health Center would increase 20% under the new proposed payment, from $65.24 to $81.93 per patient per month.

Additionally, five new CPT codes were proposed:

CPT 99X21 — Chronic care management services each additional 30 minutes by a physician or other qualified health care  professional, per calendar month (List separately in addition to code for primary procedure)

CPT 99X22 — Principal care management services for a single high-risk disease first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month

CPT 99X23 — Principal care management services for a single high-risk disease each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

CPT 99X24 — Principal care management services, for a single high-risk disease first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month

CPT 99X25 — Principal care management services, for a single high-risk disease each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)


Code
Descriptor
2021 Payment
2022 Proposed Payment
Difference
99490
CCM, clinical staff, initial 20 min
$41.17
$63.47
+$22.30
99439
CCM, clinical staff, +20 min
$37.69
$49.36
+$11.67
99491
CCM, physician/NPP, 30 min
$82.53
$84.29
+$1.76
99X21
CCM, physician/NPP, +30 min
n/a
$60.11
n/a
99487
CCCM, clinical staff, 60 min
$91.77
$138.35
+$46.58
99489
CCCM, clinical staff, +30 min
$43.97
$71.86
+$27.89
99X22
PCM, physician/NPP, 30 min
$90.37
$81.60
-$8.77
99X23
PCM, physician/NPP, +30 min
n/a
$59.44
n/a
99X24
PCM, clinical staff, 30 min
$38.73
$63.13
+24.40
99X25
PCM, clinical staff, +30 min
n/a
$65.24
n/a
G0511
Care management, RHC/FQHC*
$65.24
$81.93
$16.70

If these proposed changes take effect, reimbursement potential could increase by 150% while increasing support for patients who have a higher risk of hospitalization between physician visits when they need it most. Also note that Medicare saves approximately $900 per patient annually when a patient is enrolled in the CCM program.

As 2021 nears its finale, practices exploring CCM adoption or upgrade have more tools than ever to ensure sustainable chronic care, starting with the [FACTSHEET] Proposed Medicare CMS codes and fee changes—what they could mean for you.

Additionally, you can download our comprehensive Doctor’s and Administrator’s Guide: 2021 CCM and RPM, CPT codes and qualification [Winter].

The best option, however, is to make the most of your time and our care coordination insight as doctors: Click here to schedule a CCM (or RPM) patient care & profit assessment.

Since 2016, Vital Health Links has been a chronic and remote patient care partner and an industry leader in doctor-led, dedicated, clinical care coordination. For updates and insights to add sustainable value to your practice and patient care, subscribe here.

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