CMS Publishes Final Rule for 2022 Chronic Care Management Reimbursement

CMS Publishes Final Rule for 2022 Chronic Care Management Reimbursement
CMS Publishes Final Rule for 2022 Chronic Care Management Reimbursement

CMS Publishes Final Rule for 2022 Chronic Care Management Reimbursement

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
BASIC CCM
99490 At least 20 minutes in a given month $41 +51% $62
99439 Additional 20 minutes $38 +23% $47
COMPLEX CCM
99487 At least 60 minutes in a given month $92 +41% $130
99489 Each additional 30 minutes in a given month $44 +56% $69
BEHAVIORAL HEALTH
99484 At least 20 minutes in a given month $47 -8% $43
National payment amounts, rounded non-facility price*

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
National payment amounts, rounded non-facility price*

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