2022 Medicare CPT Code Reimbursements for Chronic Care Management
How did Medicare reimbursements for chronic care management change for 2022?
Following the 2022 Final Rule issued by CMS, if there was one word to describe the adjustments made to the reimbursements for the chronic care management (CCM) CPT codes, that word would be “significant.” While the end of 2021 was a real nail-biter for physicians and health systems everywhere as regulators and lawmakers wrangled over reimbursement rates up until the last minute, it was clear from the moment the Final Rule was issued that 2022 was going to be a big win for CCM and value-based care. The Relative Value Unit (RVU) Multiplier, which affects reimbursement rates for all CPT codes, was initially set to decrease over 3% in 2022 from 34.89 to 33.59; however, on Dec. 10, lawmakers amended the reimbursement changes and dampened effects to the RVU Multiplier, which is now set at 34.60, a much smaller decrease compared to what CMS had originally proposed. Using the updated RVU Multiplier, nearly all CPT codes for CCM will see a massive increase in the average reimbursement rate, including a 52% increase for 99490 (Basic CCM) and a 44% increase for 99487 (Complex CCM). Add-on codes for both reimbursement codes also get significant boosts of 26% and 55% respectively. Here are the CCM CPT Code reimbursement rates for 2022:
| 2022 CCM Reimbursement Rates | ||
|---|---|---|
| CPT Code | Time Spent By Clinical Staff | Reimbursement |
| BASIC CCM | ||
| 99490 | At least 20 minutes of clinical staff time per calendar month. | $64 |
| 99439 | Additional 20 minutes of clinical staff time per calendar month, up to two times. | $48 |
Basic CCM Breakdown
CPT codes 99490 and 99439 are foundational procedures in chronic care management. To qualify for 99490, patients must have two or more chronic conditions they expect to have for at least 12 months or indefinitely. For a provider to bill, there must be documented verbal consent from the patient to enroll in CCM services, a comprehensive care plan and the patient must receive a minimum of 20 minutes of CCM services from clinical staff within a given month. All the same requirements apply for 99439. This code simply reimburses for additional time spent with patients beyond the initial 20 minutes covered by 99490. Billing for this code requires a minimum of 20 minutes of time spent with clinical staff each time 99439 is billed. The maximum number of times that 99439 can be billed in a given month is two (2).
| 2022 CCM Reimbursement Rates | ||
|---|---|---|
| CPT Code | Time Spent By Clinical Staff | Reimbursement |
| COMPLEX CCM | ||
| 99487 | At least 60 minutes per calendar month. | $134 |
| 99489 | Each additional 30 minutes in a calendar month. | $71 |
Complex CCM Breakdown
The key difference between Basic (99490) and Complex CCM (99487) is the complexity in medical decision making and the time spent. In addition to requirements under Basic CCM, for a patient to qualify as complex requires acknowledgement by both the provider and the patient of an acute exacerbation. To bill for this code, a patient must receive a minimum of 60 minutes of CCM services from clinical staff within a given month. Similar to Basic CCM, 99487 also has an add-on code (99489), which allows for billing for additional time spent beyond the initial 60 minutes, in increments of 30 minutes within a given month.
| 2022 CCM Reimbursement Rate | ||
|---|---|---|
| CPT Code | Time Spent By Clinical Staff | Reimbursement |
| BEHAVIORAL HEALTH | ||
| 99484 | At least 20 minutes per calendar month | $45 |
Behavioral Health Breakdown
Under 99484, Medicare also reimburses for remote behavioral health case management. This code wraps up a range of functions including initial assessment, follow-up monitoring and facilitating therapies. 99484 is the only behavioral health CCM CPT code offered to primary care practices and was also the only CCM code that did not increase from 2021 to 2022. To qualify, a patient must have at least one behavioral health condition and receive a minimum of 20 minutes of behavioral health services from clinical staff within a given month. The provider must also obtain separate enrollment and consent and a separate care plan.
* All rates calculated using the 2022 RVU multiplier of 34.60 and total non-facility RVUs
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