MEDICARE ROLLS OUT PRINCIPAL CARE MANAGEMENT (PCM) AND ALLOWS GENERAL SUPERVISION FOR CERTAIN CARE MANAGEMENT CODES INCLUDING REMOTE PATIENT MONITORING (RPM)

November 1^st 2019- Medicare released its final physician fee schedule for the calendar year 2020 that includes a paradigm shift in care management services. Care management services are designated health services that can be provided under the general supervision of the physician.

CMS have also 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 their primary care doctor. Sargas Pharmaceutical Adherence and Compliance (SPAC) International offers its Chronic Care Management Cloud® and
SPAC Chronic Care Management Physician, Patient and Pharmacy Portals® platform to hospitals, practices, and health plans to improve patient outcomes and their bottom line. CMS has also published the final fee schedule on its website.

Or please see the highlighted sections at

https://spacinternational.com/pdf/Changes%20for%20CY%202020%20in%20CCM.pdf

Or brief summary at

http://bit.ly/2rNhGqp

Git Patel, CEO of Sargas Pharmaceutical Adherence and Compliance (SPAC) International applauded the efforts made by Medicare saying,

“With these changes from CMS, our clients can now benefit by having companies, like ourselves, provide their services. This allows for relationships to become established between hospitals and third party companies reducing the overall Medicare costs and delivering better outcomes to patients” 

Final CY 2020 Physician Fee Schedule Care Management Codes:

Chronic Care Management (CCM):

• CPT 99490 for 20 minutes of CCM time ( approx.. $42)
• CPT G2058 each additional 20 minutes billed maximum of two times per month (approx.$42)
• CPT 99487 for 60 minutes of Complex CCM time (approx.. $94)
• CPT 99489 for each 30 minutes of additional Complex CCM time (approx.. $47)
• CPT 99491 CCM services provided by physician or by QHP for 30 minutes (approx.. $84)

The 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, taking approximately 40 minutes of CCM time one would pay around $84. G2058 can be billed two times per month. It is also highly recommended to bill the Complex Chronic Codes when it reaches 60 minutes (if appropriate).

Principal Care Management (PCM)

 (Comprehensive care management services for a single high-risk disease, e.g., Principal Care Management, would take 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).

(The comprehensive care management for a single high-risk disease services, e.g. Principal Care Management would take at least 30 minutes of clinical staff time as directed by a physician or other qualified health care professional, per calendar month. General Supervision is allowed in this case).

There are also a few restrictions to guide the billing of PCM:

• It 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 separately for each service. 

Remote Patient Monitoring (RPM)

For the RPM for the year 2020, there are two major changes that have been announced. To improve general supervision, CMS is adding another add-on twenty minute code so that practitioners, payers and hospitals can formulate a contract with a third party to provide the services under the general supervision. 

• 99453: Initial enrollment ( approx.. $21)
• 99454: Device Monthly code ( approx.. $64)
• 99457: first 20 minutes of monitoring clinical staff(approx.. $54)
• 99458: New Code for “additional 20 minutes of RPM time”(approx.. $54)

Transitional Care Management (TCM):

Most of the TCM program remains the same; however, there are few changes:

• Increased payments 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). 

The new changes will be effective as from next year.

About Sargas Pharmaceutical Adherence and Compliance (SPAC) International 

SPAC International is a company that develops innovative software and mHealth applications to keep physicians and patients engaged from the time a script is initiated through the entire treatment process. The approach of our company towards treatment management enables cancer patients to reap the maximum benefits and get the best outcomes, while reducing costs to the healthcare system. The company also founded the HIPAA Compliant Cloud Portal that allows in real time, patient's critical health information exchange among various providers. Our company is focused on creating a seamless connection between the physicians, patients, insurance companies, hospitals, pharmacies and pharmaceutical companies such that the patient gets the care everyone wants, when they want it by utilizing the latest communication technologies, software and compassionate staff.

Contact Information

Name: Gitesh Patel

Website: https://spacinternational.com/

Email: gpatel@spacinternational.com