On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the 2023 Medicare Physician Fee Schedule (PFS) with changes in CPT codes. Here’s the list of the most significant telehealth CPT codes-related changes:
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Removal of Audio-only CPT Codes
Discontinuing reimbursement of telephone (audio-only) evaluation and management (E/M) services (CPT codes 99441-99443) from the Medicare Telehealth Services List
2. Introduction of Chronic Pain Management (CPM)
For chronic pain management and treatment, the monthly bundle includes:
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diagnosis
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management of a valid pain rating tool or scale
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the development, execution, revision, and/or maintenance of a patient-centered care plan including strengths, objectives, clinical requirements, and desired results
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overall treatment administration
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facilitation and management of any essential behavioral health treatment
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medication administration
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facilitation and management of any essential behavioral health treatment
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pain and health literacy counseling
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any essential chronic pain-related crisis care
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ongoing communication and care coordination between relevant practitioners furnishing care (e.g. community-based care and complementary and integrative approaches, occupational therapy and physical therapy), as appropriate
G3002 – Chronic pain management - initial face-to-face visit at least 30 minutes by a physician or other qualified healthcare professionals (QHP) per calendar month - $93.81
G3003 - Chronic pain management - Each additional 15 minutes by a physician or other qualified healthcare professionals (QHP), per calendar month - $34.31
3. Introduction of New Remote Therapeutic Monitoring (RTM) code
CPT 98978 – RTM - Daily recording & transmission of vitals - every 30 days, minimum of 16 days of readings to monitor cognitive behavioral therapy (CBT)
4. New Codes Under Evaluation and Management (E/M)
G0316 - Prolonged hospital inpatient or observation care E/M beyond the total time for the primary service - each additional 15 minutes by the physician or QHP - $36.48
G0317 - Prolonged nursing facility E/M beyond the total time for the primary service - each additional 15 minutes by the physician or QHP - $36.48
G0318 - Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service - each additional 15 minutes by the physician or QHP - $35.55
Want to Learn More?
For more information on chronic care management, remote patient monitoring, telehealth, digital health, and other innovations, visit www.hifinite.com. Stay tuned as we take a deeper dive into each of these CPT codes over the coming days. Contact us if you need assistance in understanding these changes and/or submitting CMS reimbursements to CMS.
Reference
The new list of codes related to telehealth services list can be found at:
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes