CCM Reimbursement Scheme 2022

CMS shows strong support for Chronic Care Management in 2023 by adding more codes.

Chronic Care Management

CMS released their 2023 Medicare Physician Fee Schedule Final Ruling last month and it has some really good news for Chronic Care Management, Complex Chronic Care Management, and Principal Care Management for the year 2023 while some not-so-good news for Remote Patient Monitoring reimbursement. Below is the overview of the codes that have been added as well as their national average rates as compared to 2022. As usual, make sure to check with your local geographic area adjustments, MAC’s and your billing department for guidance.

1: Expanded set of codes for chronic care management and increased reimbursement

CMS explanation of CCM is as follows:

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: 

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient 
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline 
  • Comprehensive care plan established, implemented, revised, or monitored
CodeDescription2022 National Allowed Amount2023 National Allowed AmountDifference2023 NJ Allowed Amount
9949020 min Clinical Staff CCM$64.02$62.69– $1.33$67.32
99439Add 20 min Clinical Staff CCM$48.45$47.44– $1.01$51.16
9949130 min, Phy/NP CCM$86.17$85.06– $1.11$90.91
99437Add 30 min, Phy/NP CCM$61.25$59.98– $1.27$64.28
Chronic Care Management reimbursement comparison 2022 vs 2023

2: Complex Chronic Care Management reimbursement

Complex Chronic Care Management includes everything from CCM + Moderate or highly complex decision making. It is interesting to note that if you spend 60 min of clinical staff time with a patient, you can either bill for 99487 or a combination of 1 unit of 99490 and 2 units of 99439. The former pays ~$144.03 while the later pays ~$162.2 so with a ~$18 difference, there is little reason to bill for Complex Chronic Care Management.

CodeDescription2022 National Allowed Amount2023 National Allowed AmountDifference2023 NJ Allowed Amount
9948760 min, Clinical Staff CCCM$134.27$133.18– $1.09$144.03
99489Add 30 min, Clinical Staff CCCM$70.60$70.49– $0.11$76.08
Complex Chronic Care Management reimbursement comparison 2022 vs 2023

3: Principal Care Management

A qualifying condition for Principal Care Management (PCM) services may be expected to last between three months to one year or until the death of the patient. The initiation of a PCM service will typically be triggered by an exacerbation of the patient’s chronic condition or recent hospitalization. The patient’s primary care physician will still supervise the patient’s overall care, but a specialist will manage services for the specific chronic condition.

This code is a great opportunity for specialists to manage their patient’s disease-specific condition(s) while removing the burden of managing additional chronic conditions the patients have that are not relevant to the physician’s specialty.

CodeDescription2022 National Allowed Amount2023 National Allowed AmountDifference 2023 NJ Allowed Amount
9942430 min, Physician/NPP, PCM.$83.40$81.33– $2.07$86.87
99425Add. 30 min, Physician/NPP, PCM.$60.22$58.29– $1.93$62.37
9942630 min, Clinical Staff, PCM.$63.33$61.34– $1.99$65.76
99427PCM, Clinical Staff, +30 min. $48.45$47.44– $1.01$51.06
Principal Care Management reimbursement comparison 2022 vs 2023

4: Remote Patient Monitoring

Remote patient monitoring has seen explosive growth in adaption especially after the outbreak of Covid-19. VA is set to spend $1 billion to expand its roll-out of RPM. Unfortunately, CMS has decided to cut down the reimbursement of the device code 99454 by about $5.57 in spite of stakeholders’ complaints that the original fee schedule was not enough to pay for these hi-tech devices. RPM can be a tricky roll-out and practices that have worked with companies like Healthmote have benefitted tremendously from the deep experience of patient engagement and interactions.

CodeDescription2022 National Allowed Amount2023 National Allowed AmountDifference 2023 NJ Allowed Amount
99453Patient Education & Setup.$19.03$19.32+ $0.29$21.64
99454RPM Device Supply & Data Transmissions (30 Days).$55.72$50.15– $5.57$56.34
9909130 min, Data Analysis, and Interpretation.$56.41$54.22– $2.19$57.48
9945720 min, Clinical Staff, Treatment Management Services.$50.18$48.80– $1.38$52.94
99458Add. 20 min, Clinical Staff, Treatment Management Services. $40.84$39.65– $1.19$42.66
Remote Patient Monitoring reimbursement comparison 2022 vs 2023
Avatar for Rick Crespo
Author: Rick CrespoMy self Rick Crespo and i am Healthmote’s Director of Sales & Customer Success. I have over 10 years of experience in healthcare solving problems related to quality, cost, and technology. Prior to joining Healthmote, I served as Manager of Practice Transformation at Hackensack Meridian Health Network. I was responsible quality performance for both the Medicare ACO and the clinically integrated network. Prior to that, I was a Physician Coordinator with New Jersey Innovation Institute where he worked under a grant to drive adoption of EHR’s in ambulatory offices statewide. I holds a Bachelor of Arts degree in Business Administration from Muhlenberg College. I have previously been certified as an expert in NCQA’s Patient Centered Medical Home and has held multiple health IT certifications. Email: Rick@healthmote.com Mobile: (732)703-6653
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