When CMS announced their new codes for the 2020 year, a new category of care was introduced, principal care management. Just what is principal care management? Principal care management was created for the treatment of those with only one chronic condition. Previously there were only codes in place for those being treated for two or more chronic diseases (see Chronic Care Management).
Millions throughout the United States suffer from one or more chronic diseases. In fact, 6 in 10 Americans have at least one chronic disease and 4 in 10 have more than one chronic condition.¹ Chronic condition care accounts for a significant portion of health care spending in the United States. 90% of health care costs alone are a result of chronic condition treatment and mental health treatment.² Chronic conditions especially impact the Medicare population. Over 68% of Medicare beneficiaries have two or more chronic conditions and over 36% have four or more chronic conditions. The spending on this care is costly with 93% of Medicare spending resulting from two-thirds of Medicare beneficiaries with two or more chronic conditions.³
To address the need for classification of treatment for patients with one chronic condition, CMS created codes G2064 and G2065. A chronic condition, in this case, is defined by CMS as one lasting three months to a year or until the patient’s death.
- Code G2064 is to be used for 30 minutes or more of comprehensive care by a physician or other qualified health care professional for a single chronic condition per calendar month.
- Code G2065 was created for 30 minutes of clinical care staff time approved by a physician or other medical professional per calendar month.
CMS expects this care to occur when the patient’s condition requires care unable to be done in a primary care setting and instead with the need of a specialist’s intervention.
Certintell provides solutions to optimize care coordination for community health center patients, specifically those with a chronic condition who use Medicare. Our chronic care management solutions focus on behavior change coaching by our care coaches to increase patient and physician satisfaction and improve quality of care. We go above and beyond CMS expectations for CCM by providing not only telephonic solutions but also asynchronous secure messaging and remote patient monitoring (RPM) services. Our care coaches are trained for clinical settings and we automate billing, making submitting claims much easier for the practitioner.
Learn more about the chronic care management services Certintell offers, and see how we can help you.
¹ “Chronic Diseases in America.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Oct. 2019, www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm.
² “Health and Economic Costs of Chronic Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Oct. 2019, www.cdc.gov/chronicdisease/about/costs/index.htm.
³ “Preventing Chronic Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/pcd/issues/2013/12_0137.htm.
