The Centers for Medicare & Medicaid Services (CMS) has released the 2023 updates for Chronic Care Management (CCM). CCM is a Medicare program that manages patients with two or more chronic conditions, and it has several billing codes associated with it.
There were no major changes to CMS rules and regulations in CMS 2023 Final Rule, but there are updated reimbursement rates for the CPT codes that cover CCM. Keep in mind that the codes are based on national averages, which may vary in your area. For the exact current rate based on your location, visit the Physician Fee Schedule website.
There are three series of codes for CCM: non-complex, complex, and physician-driven codes. These series vary depending on the time spent on care management, who provides the service, as well as the complexity of the service. You can only bill for one series of CCM services per patient per month, and ThoroughCare suggests that you drop the claim with the highest reimbursement at the end of the month.
The non-complex clinical staff CCM codes include code 99490, which is 20 minutes of non-face-to-face CCM services done by clinical staff, and has a current national average reimbursement of about $62. The next code is the add-on code 99439, which is an additional 20 minutes of non-face-to-face CCM services done by clinical staff, and has a national average reimbursement of $47. You can bill code 99439 up to two times per month, so at 40 and 60 minutes of time.
If you’re a Rural Health Clinic or Federally Qualified Health Center, you will bill a separate code, G0511. This is a General Care Coordination code and is the only code you can bill for CCM services. G0511 is for at least 20 minutes of non-face-to-face services and can only be billed one time per month, with a reimbursement average of about $78.
The CPT codes for physician-driven, non-complex CCM include code 99491 for 30 minutes of physician non-face-to-face CCM time, with a national average reimbursement rate of $85. There is also an add-on code 99437 for an additional 30 minutes of physician time billed at 60 minutes with code 99491, with a national average reimbursement rate of $60 for a total reimbursement of $145.
Finally, the CPT codes for complex Chronic Care Management include code 99487 for 60 minutes of complex CCM services, with a national average of $133 per patient per month. There is an add-on code 99489 for 30 additional minutes of complex CCM services, which is billed at 90 minutes with code 99487, with a national average reimbursement rate of $70 for a total of $203 when billed at 90 minutes. You can bill 99489 an unlimited amount of time, so at 90, 120, 150 plus minutes.
If you are faced with a situation where 60 minutes of time are needed under both non-complex and complex services, you should bill non-complex 99490 + 99439 times two because it ultimately pays more and takes the complexity in decision-making out of the equation.
If you’d like to learn more about Chronic Care Management and its billing codes, connect with us at info@lynkhealthcare.com.