On Nov. 2, the Centers for Medicare and Medicaid Services published its final rule updating CPT codes and reimbursement rates for 2022.
The new rates, with some significant boosts for chronic care management services, suggest that CMS is bullish on chronic care management and remote patient monitoring.
The changes were part of sweeping annual updates to the way Medicare reimburses physicians and other medical professionals.
The new rates, particularly for CCM, published in the 2022 Medicare Physician Fee Schedule Final Rule, show slightly muted increases compared to what had been originally proposed, but significant nonetheless.
For example, Medicare raised the reimbursement rate more than 50% for 99490, which is the code for at least 20 minutes of time spent by clinical staff delivering care. That’s for basic CCM.
For complex CCM, reimbursements are up 41% for the first 60 minutes under code 99487 and up 56% for every additional 30 minutes of clinical time each month under code 99489.
The new rates go into effect on or after Jan. 1.
|2022 CCM Reimbursement Rate Changes|
|CPT CODE||TIME SPENT BY CLINICAL STAFF||OLD RATE||RATE PERCENTAGE CHANGE||NEW RATE|
|99490||At least 20 minutes in a given month||$41||+51%||$62|
|99439||Additional 20 minutes||$38||+23%||$47|
|99487||At least 60 minutes in a given month||$92||+41%||$130|
|99489||Each additional 30 minutes in a given month||$44||+56%||$69|
|99484||At least 20 minutes in a given month||$47||-8%||$43|
Remote patient monitoring sees less dramatic changes, some codes reduced
While CCM saw significant rate increases, remote patient monitoring was less dramatic. Indeed, CMS appears to have reduced reimbursements for more automated services, for example code 99454 and code 99091, which require less human interaction or none at all.
Reimbursements, however, increased for the codes that require human interaction, for example initial device setup (up 13%), and 99457, which covers monitoring and treatment in which communication is involved.
|2022 RPM Reimbursement Rates Changes|
|CPT CODE||WHAT IT COVERS||OLD RATE||RATE PERCENTAGE CHANGE||NEW RATE|
|99453||Initial setup of device||$19||+13%||$21|
|99454||Device supply with daily recordings and programmed alerts||$63||-14%||$49|
|99457||20 minutes of monitoring and treatment management that includes interactive communication with the patient or caregiver during the calendar month||$51||+4%||$49|
|99458||Each additional 20 minutes of monitoring and treatment management services provided.||$42||-6%||$40|
|99091||30 minutes of monitoring each 30 days that does not require interactive communication||$57||-4%||$55|