In the year 2015, the Centers for Medicare and Medicaid Services (CMS) launched Current Procedural Terminology (CPT) codes to reimburse providers for their remote care services without undergoing any loss in revenue.
The American Medical Association (AMA) defined the goal of CPT codes as to “expand reporting pathways for physicians across the country who take care of a diverse set of patients that have varying degrees of access to care.”
The CMS released the Final Medicare Physician Fee Schedule for CY 2022 that includes 405 code revisions to the full list including 249 new codes, 93 revisions, and 63 deletions.
This article aims to discuss the new 2022 codes focused on online care management for patients.
Chronic Care Management (CCM)
CPT 99437
Under the CCM section, a new code 99437 was created as an add-on to 99491. The add-on code 99437 is used to report additional 30 minutes of the same service by the physician or a qualified healthcare professional in the same calendar month. If you want to use the CPT code 99458, it should be reported with 99491.
CPT 99439
Under the CCM section, the add-on code 99439 is used to report additional 30 minutes by the clinical staff directed by a physician or qualified health care professional in the same calendar month. It can be billed at the same time as 99490 and can be used twice at most per month.
G2058
The add-on code G2058 is used to report additional 20 minutes by the physician or qualified healthcare professional. It represents comprehensive assessment & care planning which can be billed only once with annual wellness visits to initiate CCM.
Remote Therapeutic Monitoring (RTM) – (Respiratory system status, musculoskeletal system status, therapy adherence, therapy response)
CPT 98975
Initial set-up and patient education; one-time payment service by a physician or other qualified healthcare professional who cannot independently order and bill for E/M services
CPT 98976
Daily recording and transmission of vitals for ≥ 30 minutes - every 30 days, minimum of 16 days of readings to monitor respiratory system reported by a physician or other qualified healthcare professional who cannot independently order and bill for E/M services.
CPT 98977
Daily recording and transmission of vitals for ≥ 30 minutes - every 30 days, minimum of 16 days of readings to monitor musculoskeletal system reported by a physician or other qualified healthcare professional who cannot independently order and bill for E/M services.
CPT 98980
Interactive communication per calendar month for the first 20 minutes by a physician or other qualified healthcare professional who cannot independently order and bill for E/M services
CPT 98981
Interactive communication per calendar month for each additional 20 minutes by a physician or other qualified healthcare professional who cannot independently order and bill for E/M services
Principal Care Management (PCM)
CPT 99424
The code G2064 is replaced with CPT 99424. This code is used to report ≥ 30 minutes by the physician or qualified health care professional in the same calendar month. It can be billed concurrently with RPM but not with CCM for the same patient/calendar month. While reporting this code, a disease-specific care plan is created, unlike CCM’s comprehensive care plan.
CPT 99426
The code G2065 is replaced with CPT 99426. This code is used to report ≥ 30 minutes by the clinical staff directed by a physician or qualified health care professional in the same calendar month. It can also be billed concurrently with RPM but not with CCM for the same patient/calendar month. While reporting this code, a disease-specific care plan is created, unlike CCM’s comprehensive care plan.
CPT 99425
Under the PCM section, the add-on code 99425 is used to report additional 30 minutes by the physician or qualified health care professional in the same calendar month.
CPT 99427
The add-on PCM code 99427 is used to report additional 30 minutes by the clinical staff directed by a physician or qualified healthcare professional.
Conclusion
Are you interested in implementing the right technology for online care management followed by getting reimbursed? Contact Hifinite Health to schedule a demo and we’ll help you generate more revenue while making timely care accessible for your patients.