2020 CMS Code Updates: Chronic Care Management (CCM)

To date Chronic Care management (CCM) involves three codes:

• CPT 99490
• CPT 99487
• CPT 99489

The Centers for Medicare & Medicaid Services (CMS) states that “Chronic Care Management continues to be underutilized” and to address this concern, beginning January 1, 2020, we see a valued impact from additional CMS support to allow for more paid time for your sickest patients.

There has been a forfeiture of time between spending 20-minutes to 60-minutes of patient care time, and the loss of patient engagement after the allowable billable time (CPT 99490) of 20 minutes for a non-complex patient. CMS has created an add on code to be billed as an additionally with CPT 99490 – this new code, for the near future, will be G2058. As of 2019, a patient without moderate to complex medical decision making will be billed for 20 minutes of service regardless if the time continues. In addition, if the staff performing the call believes the patient should have further education or support, it is then followed up on the following month.

With the New Year brings more time to invest in patient care. The new G2058 allows for an additional 20 minutes of clinical staff time per month and pays $37.89. This code may be billed concurrent to 99490, up to two times per month, per beneficiary. The total possible reimbursement for an hour or more of non-complex CCM services is $118.01. CMS does state that after 40 minutes, the care team should look at possible complex chronic codes to reach 60 minute which allows for an added impact to the complex care population that may not have received the support needed at just 20 minutes of engagement.

With the additional code, your care team will be able to continuously engage the patient for up to 60 minutes of non-complex time, even without moderate to complex medical decision making. The quality of care the patient will receive will increase due to the additional follow-up time. However, this time spent should reflect clinical need and in turn will allow staff and patients to utilize the Chronic Care Management team to its full extent.

This revision is allowing for improved patient care and supporting real time patient outcomes. With the threshold of time increased, the care team is able to engage, build a relationship of trust and move the patients care forward every month by managing patient-centered goals and educating off of the provider plan of care.

With care plans we see a minor, but significant, change for complex CCM codes 99487 and 99489. There is no longer a requirement for “substantial care plan revision”. The code descriptor will now interpret as “establishment or substantial revision of a comprehensive care plan”.  This will open up more billable time to be spent on care coordination where a substantial care plan revision is not warranted.