2021 Medicare Chronic Care Management CPT Code Updates

What changes did Medicare make to the CPT codes for Chronic Care Management for 2021?

The short answer is not very much. In the 2021 Final Rule from CMS, the only substantive change was that the stopgap code G2058 was deleted and replaced with code 99439. The descriptor for 99439 is also identical to the descriptor for G2058. This was and still is the 20 minute add-on code for Basic Chronic Care Management services. Apart from this minor change, the chronic care management program was virtually untouched by the 2021 Final Rule from CMS. As in 2020, there are three main CPT codes and two add-on CPT codes in 2021 that may be billed by primary care providers for CCM services. These are as follows:

Basic CCM CPT Codes
CPT Code Reimbursement Time Spent By Clinical Staff
99490 $42 At least 20 minutes in a given month
99439 $38 Each additional 20 minutes in a given month, up to 2 times
*Actual reimbursement varies slightly by region.

The Basic CPT code for Chronic Care Management, 99490, requires that patients must have two or more chronic conditions, as well as documented consent to enroll in the program AND receive at least 20 minutes of CCM services from clinical staff within a given month. A personalized care plan, which shows an assessment of all patient factors and identifies gaps and barriers to be addressed, is also required. The add-on code for Basic CCM is 99439 (formerly G2058). This code allows providers to bill for each additional 20 minutes of time spent for Basic CCM services in a given month, up to 2 times. For example, if CCM services were provided for at least 40 minutes with a patient in a given month that was not Complex, 99490 ($42) and 99439 ($38) would be billed together for that month. Note that we are quoting the average reimbursement for these codes. Actual reimbursements may vary depending on the region.

Complex CCM CPT Codes
CPT Code Reimbursement Time Spent By Clinical Staff
99487 $93 At least 60 minutes in a given month
99489 $45 Each additional 30 minutes in a given month
*Actual reimbursement varies slightly by region.

For Complex CCM patients, CMS offers CPT code 99487, which has a higher rate of reimbursement than the Basic CCM CPT code. To bill using this code requires moderate or high complexity in medical decision making AND acknowledgement by both patient & provider of an acute exacerbation (generally defined as a sudden worsening of a patient's condition that necessitates additional time and resources). Patient must receive at least 60 minutes of services from clinical staff within a given month to bill for this code. The same as with the Basic Chronic Care Management code, the Complex Chronic Care Management code also has an add-on CPT code to cover time spent beyond 60 minutes. That CPT code is 99489. It allows for billing for each additional 30 minutes of time spent for Complex CCM services within a given month. For example, if 90 minutes of clinical services is provided to a patient in a given month that was Complex, they would bill 99487 ($93) and 99489 ($45) for that month. Note that we are quoting the average reimbursement for these codes. Actual reimbursements may vary depending on the region.

Behavioral Health CPT Codes
CPT Code Reimbursement Time Spent By Clinical Staff
99490 $45 At least 20 minutes in a given month
*Actual reimbursement varies slightly by region.

In addition to the CPT codes for Basic and Complex Chronic Care Management, CMS also offers one Behavioral Health CPT code that can be used by primary care providers to bill for behavioral health services. That CPT code is 99484, which is for Behavioral Health Integration. This is the only behavioral health code that can be fully supported by a primary care practice. To qualify, the patient must have at least one behavioral health condition and receive at least 20 minutes of Behavioral Health Integration (BHI) services from clinical staff each month. It also requires a separate enrollment/consent form and a separate care plan. The average reimbursement for this code is $45, but again, can vary depending on the region.

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