Final FY2020 Reimbursement Rule

Recently the Centers for Medicare and Medicaid Services (CMS) has sent out their Final FY2020 Physician Fee Schedule. Immediately one thing stands out. CMS is fully committed to telehealth services for the foreseeable future. Below are the proposed changes around Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) and what it all means for you and your practice.

CMS increases payment for transitional care management and expands the scope of PAs

CMS finalized its proposal to increase Medicare transitional care management payments to recognize clinicians for the time spent managing a patient’s care after the patient leaves the hospital. Beginning in CY 2020, CMS will pay clinicians for care management services for patients who have a single high-risk medical condition, such as diabetes or high blood pressure, as opposed to the multiple chronic conditions required to receive payments in the past. CMS also will create a new add-on code to pay clinicians for additional time spent on care management activities for patients with multiple chronic conditions.

Addition of new time categories for non-Complex CCM time (99490)

Instead of one 20-minute code (CPT 99490), the proposal is to replace it with two new General Care Management codes (G-codes).

·       GCCC1: 20 minutes of initial clinical staff time per month pays around $42 (same as CPT 99490)

·       GCCC2: Additional 20 minutes of clinical staff time per month pays around $31.25

With these new codes, spending 40 minutes of CCM time would pay around $73.52. When reaching 60-minutes, it might make sense to bill the Complex Chronic Codes.

This is a step in the right direction as it was difficult to bill either 20 minutes or 60 minutes. There wasn’t any middle ground for billing. We believe this will help your practice remove the need to constantly monitor your time for CCM billing. Now your staff can use all the time they need to speak to patients effectively.

Principle Care Management (PCM) – Monitoring for one specific chronic condition

For 2020, this proposal will create a new program called PCM. The requirements are similar to CCM. The proposal would add:

·       GPPP2: 30 minutes of physician time per month – one complex chronic condition (Pays around $39.70)

The CCM requirement of two or more chronic conditions have left many patients out of the much needed care program. With this change, your practice can now add patients with one specific condition. More importantly, specialist practices can now begin to reap the gains of CCM programs.

More Money and Less Work for Remote Physiologic Monitoring (RPM) in 2020

·       New Code for “additional 20 minutes of RPM time” – 99458 (Pays around $41.08) With this change, 40 minutes of RPM time would pay about $112 a month.

·       RPM codes 99457 and 99458 are furnished under General Supervision rather than the currently required, direct Supervision.

For many practices, it was difficult to add more work to your staff. Now, not only are you allowed to bill for an extra 40 minutes, but you can outsource to a reliable 3rd party partner. This will free you and your staff’s time while still generating additional revenue.

In conclusion, practices who struggle with selling CCM and RPM services will find that CMS has now open the flood gates to hundreds of dollars in reimbursement for telehealth services.