Updated CCM Codes for 2019

Since the inception of CCM in 2015, the rules have been updated annually.  These changes are typically the result of an open-comment period where CMS listens to feedback and suggestions.  For the most part, the changes have been positive each year.

During previous CCM annual updates, CMS has made the following changes since 2015:

  • Removed Direct Supervision
  • Added a 60-minute CCM Code
  • Added a 30 additional minute CCM Code
  • Allowed Verbal consent
  • Allowed Rural Health Clinics and FQHCs to participate

For 2019, CMS made some interesting improvements.  At ThoroughCare, here are the 3 biggest changes that our practices will notice after the new year.

1.  30-minutes of Provider time in CCM:  99491 - $74.26

For providers who take an active role in monthly CCM tasks, there's a new code for you.  CMS created CPT Code 99491 to compensate providers (Doctors / Nurse practitioners) for time spent on CCM-related activities.   

(Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician time)

This new code can NOT be reported in the same month as CPT codes 99490 and 99487.  

Oculus' Opinion: 

We  expect that some primary care providers will most likely use this code to manage higher-risk patients while allowing our RNs / MAs to continue services for 99490.   Providers will need to decide whether this code is a good use of their time.   This code is now available for practices to use beginning January 2019. Please note that you still need a detailed care plan and 24/7 support services to meet other regulatory  requirements

2.  Increased Reimbursement for RHCs/FQHCs - $65

In 2018, Rural Health Clinics and FQHCs received a new code for CCM:  G0511.  This new reimbursement paid an average of the 3 fee-for-service CCM codes ($62).  While RHCs and FQHCs won't be able to utilize the new 99491 code (mentioned above), it's rate is now taken into consideration in determining the value of G0511.  This will increase the reimbursement from $62 to $65 for G0511 beginning in January 2019.

Oculus' Opinion: 

This is incredible news for RHCs and FQHCs.  At $65, CCM is a no-brainer for these groups.  Managing 200 CCMs will generate $13,000 in monthly revenue.  We are extremely excited about this new increase.  We encourage every RHC and FQHC to immediately begin a CCM program.

3.  Remote Patient Monitoring (RPM)

Remote patient monitoring is the process of tracking, monitoring and discussing patient data.  Examples include:  Weight, Blood pressure, activity, sleep, blood glucose and others.

CMS started covering RPM in 2018 with code 99091, but the requirements presented some difficulty for providers.  The 30-minute time requirement proved to be difficult too.

In 2019, the RPM requirements are significantly improved.  CMS added 3 new codes:

  • 99453:   Remote monitoring of physiologic parameters like weight, blood pressure, pulseox, respiratory flow rate and others.  This code pays for the initial set-up and education on the use of the equipment. Pays $21
  • 99454:   Remote monitoring of physiologic parameters  like weight, blood pressure, pulseox, respiratory flow rate and others. This code is for monitoring the daily recording(s) or programmed alert(s) transmission, each 30 days.  Pays $69
  • 99457:   Remote physiologic monitoring treatment management services, 20 mins (or more) of clinical staff time in a calendar month requiring interactive communication with the patient/caregiver during the month.  Pays $54

All of these codes can be used in the same month in ADDITION to CCM.

Oculus's Opinion: 

We're extremely excited about the opportunities around Remote patient monitoring.  Oculus has a solutions wtih RPM module to allow patients to report their data (both automatically through integrated devices AND manually through a portal). 

We have integrated over 384 devices and apps including Apple Health and Google Fit.