The Chronic Care Management guidelines are updated each year by CMS. Some years have significant changes and others are mild with only a few details. Paying close attention and making adjustments is critical however as we all must use the correct codes and rates for documentation and billing.
CMS Medicare Physician Fee Schedule Final Rule for 2023
The 2022 fee schedules for Chronic Care Management remain intact for 2023. Everything will carry over nicely without requirements for major adjustments to encounter length or billing codes. Changes have occurred specifically for Behavioral Health, Pain Management and Opioid Treatments. If you bill to those code sets, read the final rule carefully and update as directed.
Changes of Note for 2023
A few changes exist outside of the CCM codes. The following are updates noted in the Final Rule. Read the full ruling for details specific to your internal processes and organization.
Behavioral Health
CMS is working to remove barriers to reaching behavioral health services and professionals. An exception to the direct supervision requirement is being implemented “under regulation at 42 CFR 410.26” to encompass physicians and non-physician practitioners. They are also working through a proposal for psychiatric diagnostic evaluation to qualify as the initiating visit for BHI services.
Pain Management
Changes to chronic pain management are underway with a focus on accuracy. New HCPCS codes labeled G3002 and G3003 are designed for more accurate billing and ease of entry for medical practitioners and Medicare beneficiaries.
Opioid Treatments
Changes are focused on price stabilization for methadone. The payment will be based on HCPCS codes G2067 and G2078 with updates to the amounts annually in order to account for inflation.
CCM Codes and Rates (same as 2022)
The CCM CPT codes for 2023 are split between standard CCM and Complex CCM. The complex group applies to those requiring additional consultation beyond the standard program. Different rate reimbursements associated with each code are listed below.
Chronic Care CPT Codes
- 99490 – This CPT code includes two primary care situations. The first 30 minutes of care provided by a physician or non-physician practitioner is reimbursed at $86.17.
Additionally, a minimum 20 minutes (cumulative) in a 30-day period of not in-person monitoring of the care plan is reimbursed at $64.02.
- 99439 – Under this CPT code, subsequent 20 minutes of care by clinical staff is reimbursed at $48.45.
Subsequent care by a physician or non-physician practitioner is reimbursed at $61.25.
Complex Chronic Care CPT Codes
- 99487 – Minimum of 60 minutes (cumulative) over 30 days of not in-person consultation time toward establishing or monitoring chronic conditions care plan. Reimbursed at $134.27.
- 99489 – Billed alongside CPT 99487 for every additional 30-minute consultation (not in-person). Reimbursed at $70.60.
Why CCM Matters in Your Clinic?
Chronic Care Management is designed to benefit healthcare providers and Medicare beneficiaries by reinforcing treatment plans outside of the clinical environment. Clinicians are busy with visiting patients and CCM creates follow-up communications to help patients stay on track while encouraging clinical visits when necessary.
More Revenue for your FQHC, RHC, or Private Clinic
CCM programs also generate revenue while serving the patient population. Use this handy revenue calculator to see how engaging in CCM can benefit your clinic. Incremental cash flow allows clinics to invest in new patient programs, equipment, supplies, and other resources that benefit their healthcare teams and patient population alike.
Better Outcomes for your Patients
While CCM generates revenue, the real benefits focus on better patient outcomes and more consistent support for self-management of multiple chronic conditions. Our team is dedicated to helping your patients, on your terms while adhering to your internal systems for seamless integrations.
Read our full Chronic Care Management Guide to see how your clinic and patients can benefit from working with a dedicated CCM partner.
Start earning new revenue for your clinic and provide better patient care when you sign up for your risk-free, no-cost-to-start CCM program with H3C.
