On November 1, 2019. Medicare released its final physician fee schedule for calendar year 2020 that includes paradigm shift in care management services which are designated health services meaning can be provided under the general supervision of the physician. CMS has added Principal Care Management for one complex chronic condition that may be billed by specialists while the patient is getting Chronic Care Management services from the primary care doctor. Sargas has been offering its care management and care coordination platform to hospitals, practices and health plans to improve patient outcomes and their bottom line. Please see pages 390 to 436 of the final fee schedule at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F.html
With these changes from CMS, our clients can now benefit by having companies like us provide the services. This allows for relationships that would be established between hospitals and third party companies that will reduce the overall medicare costs while delivering better outcomes to patients said Git Patel, CEO of Sargas International.
Chronic Care Management (CCM):
- CPT 99490 for 20 minutes of CCM time ($42)
- CPT G2058 each additional 20 minutes billed maximum of two times per month ($42)
- CPT 99487 for 60 minutes of Complex CCM time ($94)
- CPT 99489 for each 30 minutes of additional Complex CCM time ($47)
- CPT 99491 CCM services provided by physician or by QHP for 30 minutes ($84)
Care plan is established, implemented, revised or monitored will mean the same as establishment or substantial revision of comprehensive care plan for these two codes.
With these new codes, spending 40 minutes of CCM time would pay around $84. G2058 can be billed two times per month. When reaching 60-minutes, it might make sense to bill the Complex Chronic Codes (if appropriate).
Principal Care Management (PCM)(NEW)
Specialists can bill this while primary care bills for CCM. Primary care can also bill this for one chronic condition:
- G2064: 30 minutes of physician time per month – one complex chronic condition ($84)
- G2065: 30-minutes of clinical staff time per month – one complex chronic condition ($56)
(Comprehensive care management services for a single high-risk disease, e.g., Principal Care Management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: One complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities).
(Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. General Supervision is allowed).
Cannot be billed with CCM by same physician, BHI, ESRD payments and also during the surgical global period. RPM can be billed by the same physician as long the times are counted separate for each service.
Remote Patient Monitoring (RPM):
For 2020, there are two significant changes that is CMS is adding another add on twenty minute code for monitoring and allows for general supervision so that Practices, Payors, Hospitals can contract with third party to provide the services under the general supervision.
- 99453: Initial enrollment ($21)
- 99454: Device Monthly code ($64)
- 99457: first 20 minutes of monitoring clinical staff($54)
- 99458: New Code for “additional 20 minutes of RPM time”($54)
Transitional Care Management (TCM):
While there are no significant changes to this program, there are two impactful changes:
- Increased payment for TCM :
- 99495 (Moderate) = Increased to 2.36 work RVUs
- 99496 (Complex) = Increased to 3.10 work RVUs
CMS is allowing to bill 16 codes concurrently with TCM (99358, 99359, 93792, 93793, 90960, 90961, 90962, 90966, 90970, 99091, 99487, 99489, 99490, 99491, G0181, G0182).
|CY 2020 Physician Fee Schedule Final Rule|
|Designated Care Management Services Assigned General Supervision|
|99484||Care manage serv minimum 20|
|99457||Rem physiol mntr 1st 20 min|
|99458||Rem physiol mntr ea addl 20|
|99487||Cmplx chron care w/o pt vsit|
|99489||Cmplx chron care addl 30 min|
|99490||Chron care mgmt srvc 20 min|
|99492||Init psych care manag, 70min|
|99493||Subseq psych care man,60 mi|
|99494||Init/Sub psych care add 30 m|
|99495†||Trans care mgmt 14 day disch|
|99496†||Trans care mgmt 7 day disch|
|G2058||CCM add 20min|
|G2065||Clin mang h risk dx 30|
|G2086||Off base opioid tx first m|
|G2087||Off base opioid tx, sub m|
|G2088||Off opioid tx month add 30|
|The face-to-face visit included in the service is not assigned general supervision|