The most efficient and result-oriented method of managing chronic diseases is implementing Chronic Care Management (CCM) and Remote Patient Monitoring (RPM). Both of them come with their unique benefits and billing guidelines. The CCM and RPM reimbursement procedures have recently been updated in the 2024 final rule for the Physician Fee Schedule (PFS) by the Centers for Medicare & Medicaid Services (CMS).
Chronic Care Management (CCM) refers to the long-term planning and delivery of healthcare services to people with chronic illnesses, like asthma, diabetes, heart ailments, hypertension, cancer, and others. Continuous care allows easy management of symptoms, prevents complications, and improves general health, thereby decreasing severe health risks.
Remote Patient Monitoring (RPM) is a form of technically advanced chronic care that allows medical professionals to keep a consistent eye on their patients’ progress reports. Using specialized remote monitoring platforms, patient data is gathered and sent directly to medical professionals for proper assessment and care approach.
Both CCM and RPM are employed for acute, chronic, and post-operative care. RPM focuses on capturing vital health data including BP, heart rate, weight, body temperature, respiration rate, and more, and plays a critical role in managing chronic care. By using clinical software and connected devices to receive daily readings of patients’ vitals and getting alerted for any abnormalities/ warnings physicians and care coordinators can promptly intervene to avoid any complications and health emergencies.
In CCM, a wide range of treatment approaches are followed to manage and treat a patient’s chronic health condition. This comprehensive treatment approach focuses on:
The CMS recognizes CCM as a valuable primary care service that helps improve patient health and care. Not only this, CMS also acknowledges the potential benefits of RPM in conjunction with the CCM.
The eligibility for CCM includes RPM patients having two or more high-risk chronic diseases that are anticipated to continue for at least a year or until the patient passes away. The time allotted to caregiving under CCM can’t be doubled or duplicated. This means the amount of time needed and invested for each code should be met independently.
In order to qualify for this CPT code, a patient must have two chronic diseases at a minimum and see clinical staff for at least 20 minutes each month. It is not permitted to bill for 99490 and 99491 in the same month. With the average national payment rate of $61.57, the clinical staff is billed for the initial 20 minutes.
99439 is used for each additional 20 minutes of clinical staff time per calendar month, directed by a physician or qualified healthcare professional. The average national payment rate is $47.16.
The healthcare provider time for the initial 30 minutes is billed at an average national payment rate of $83.18.
With the average national payment rate of $58.62, healthcare providers can time for an additional 30 minutes, with no limit.
This is a Complex Chronic Care Management (CCCM) Code with an average national payment rate of $131.97, a minimum of 60 cumulative minutes are required during a 30-day period of remote consultation time in establishing or monitoring a treatment plan, with no limit.
The average national payment rate for this Complex Chronic Care Management (CCCM) code is $71.06 and billed along with CPT 99487 for each additional 30 minutes of non-in-person consultation, with no limit.
For Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), this is a special payment code for 20 minutes each month, with no limit. $71.68 is the average national payment rate.
This CPT code indicates service initiation, addresses patient education, and device setup for monitoring devices that check vitals, including BP, weight, pulse, blood glucose, and respiratory flow rate.
This code covers the cost of providing scheduled alert transmissions or daily recording of vitals on at least 16 unique days within 30 days. The average nationwide payment rate for this code is $46.50.
The initial 20 minutes of treatment management are included in this code with an undefined amount of interactive remote communication sessions with the patient via text, phone, email, and video in a calendar month. The average nationwide payment rate is $48.14.
This CPT code encompasses reimbursement for each additional 20 minutes of RPM sessions spent with/ on the patient a calendar month. Just like CPT 99457, the documentation of how the time is distributed is a must. The average national payment rate for this code is $38.64.
Introduced in 2022, this code is the latest one to be enrolled and has more stringent criteria than its predecessors. It accounts for a minimum of 30 minutes for healthcare professionals to collect, analyze, and process data transmitted by patients over a given calendar month. At least one phone or email exchange involving medical management or monitor advice is covered under this CPT code.
The average nationwide payment rate is $52.71.
This code cannot be reported in conjunction with codes 99457, 99458, and other codes listed in the CPT guidelines for RPM.
HealthArc is your reliable partner in enhancing chronic care and management of patient outcomes along with efficient billing. Our Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) software is designed to scale your healthcare results and make patient monitoring and management easy. Our suite of FDA-approved remote monitoring devices, patient communication and interaction capabilities, a dedicated customer success team, clinical software, physician dashboard, and billing capabilities provide a comprehensive solution.
Please request a free demo to learn about how we can help your organization achieve its care management goals. Also, feel free to talk to our team at +201 885 5571 for any queries about the CCM and RPM reimbursement changes.