The Centers for Medicare and Medicaid Services (CMS) announced new policies surrounding the use of telehealth for care management services for Medicare patients and plans to expand the use of this innovative technology to benefit patients. Starting in 2020, Medicare patients will have increased access to health care services delivered via telehealth.
New Proposed Physician Fee Schedule Codes:
- 2 New Chronic Care Management (CCM) Codes: GCCC1 and G2058
- 1 New Remote Physiologic Monitoring (RPM) Code: 99458
- 2 New Codes for the New Service of Principal Care Management (PCM): G2064 and G2065
- 2 Transitional Care Management (TCM) Reimbursement Changes: 99495 and 99496
- 3 New Codes for digital communication with a physician or other qualified health professional: 99421, 99422, and 99423
- 3 New Codes for digital communication with a non-physician health professional: 98970, 98971, and 98972
Increasing the use of telehealth for Medicare patients can save money and benefit both patients and providers. Over the next 10 years, the increase in telehealth benefits through Medicare will save enrollees $557 million.¹ These services will limit the amount of travel for patients, making it easier to receive necessary care.
The new proposed changes have a significant impact on multiple facets of care management.
CCM: As of 2019, CMS has three CPT® codes for classifying chronic care management time, 99490 for 20 minutes, 99487 for 60 minutes, and 99489 for each additional 30 minutes. The 2020 changes will replace the current 20-minute code with two new codes, GCCC1 and G2058 (originally designated GCCC2) which cover 20 minutes of initial staff time and 20 minutes of additional staff time respectively (0.54 RVU). It is important to note that for FQHCs, G0511 is the HCPCS code for CCM.
RPM: Remote patient monitoring services have additional changes in 2020, to improve the quality of care. In 2020, there will be a new add-on code for patients who receive an additional 20 minutes of RPM services (99458 with 0.5 RVUs). Additionally, RPM codes 99457 and 99458 will now be provided under General Supervision.
PCM : This year, CMS is introducing a new set of codes to cover patients with only one chronic condition, called principle care management. Code G2064 (originally designated GPPP1) covers 30 minutes of physician time per month, while G2065 (originally designated GPPP2) covers 30 minutes of clinical staff time each month for those with one chronic condition. Learn more about PCM here.
TCM: Transitional care management is also affected by the new changes. With the new codes, there are two increases in payment. Codes 99495 and 99496 are set to increase to 2.36 and 3.1 work relative value units (RVUs) respectively.
By allowing more telehealth services through these new codes, Medicare patients have additional flexibility and choice in their health care services while having more accessibility to needed care.
PLEASE NOTE: FQHCs may not bill for some of the new codes initially but future rulemaking may propose adding them
Chronic care management, remote patient monitoring, principle care management and transitional care management are all services that can be delivered through telehealth. Certintell provides numerous telehealth services, specifically in the areas of chronic care management, behavioral health integration, transitional care management and remote patient monitoring. Through innovative technology and collaboration with care coaches, Certintell powers telehealth solutions by partnering with providers to improve patient care outcomes, surpass quality measures and increase revenue opportunities for Community Health Centers.
¹ “CMS Expands Telehealth Benefits under Medicare Advantage.” JD Supra, 11 Apr. 2019, www.jdsupra.com/legalnews/cms-
LAST UPDATED: 1/6/2020