2017 is just around the corner and with it comes a number of new CPT codes, deleted codes, and code revisions. The updates made enable providers to get paid for some work that is already being done while other updates remove barriers to providing certain services such as Chronic Care Management.
As in past years, new and modified CPT codes have been released that will be effective in the new year. There are hundreds of CPT code revisions taking place across a number of specialties that could affect the codes you're using today.
Chronic Care Management Code Changes
Several changes have been made, in particular, to Medicare's billing requirements for Chronic Care Management. Under the new MPFS Final Rule, Medicare will pay physician practices for complex CCM services under two new CPT codes, 99487 and 99489.
These codes will be available to practitioners beginning January 1, 2017. These complex CCM codes require the strict satisfaction of all CCM requirements under CPT code 99490, as well as the following additional elements:
- Documented moderate or high complexity of medical decision-making; and
- At least 60 minutes of clinical staff time per month (rather than 20 minutes for regular CCM services under 99490). Code 99489 is an add-on code for each additional 30 minutes of clinical staff time after the 60 minutes under 99487.
CCM Initiative Visit - New Medicare Code G0506
CMS is establishing a new add-on billing code, G0506, which provides an additional payment for extensive, outside the usual effort, face-to-face assessment and care planning by the billing practitioner (not clinical staff) during the initiating visit, annual wellness visit (AWV), or the initial preventive physical exam (IPPE). This code can be billed in addition to the E/M, AWV, or IPPE code, but can only be billed once for a given beneficiary.
CMS clarified that G0506 cannot be billed by a single practitioner on the same day as G0505 (cognition and functional assessment) or as an add-on for the behavioral health integration (BHI) initiating visit or BHI services.
Lack of Practitioner Oversight or Clinical Integration
In the MPFS Final Rule, CMS noted that the billing practitioner is required to remain involved in the ongoing oversight, management, collaboration, and reassessment in connection with CCM. CMS warned that the CCM service elements are deemed not furnished (and therefore, not billable as CCM) if there is little oversight by the billing practitioner or if there is a lack of clinical integration between the billing practitioner and any third party that provides outsourced CCM services. CMS also stated its intent to monitor the impact of outsourcing on patient-centered care.
Relaxation of Service Elements and Billing Standards for Code 99490
Thanks to the MPFS Final Rule, the Chronic Care Management service elements and billing requirements will be relaxed starting January 1, 2017.
- The requirement to provide the beneficiary with a written or electronic copy of the care plan prior to initiating CCM has been revised so that the care plan doesn't need to be in electronic or written format.
- Obtaining a signed beneficiary consent form in order to receive CCM has also been revised. Obtaining written consent or documenting it in the medical records that the required information was explained and whether the beneficiary accepted or declined the services is now acceptable. Existing written agreements are not affected by this change.
- The requirement that CCM may only be initiated during a Medicare annual wellness visit, initial preventive physical exam, or face-to-face evaluation and management visit applies only to patients who have not been seen within 12 months prior to commencement of CCM or new patients.
- Access to the electronic care plan will no longer be required outside of normal business hours
- Continuity of care documents can be shared via fax rather than requiring clinical summaries to be transmitted electronically.
- Structured recording of patient information using a Certified EHR technology no longer includes the creation of a structured clinical summary record.
- Beneficiaries no long need to provide authorization for electronic communication of his or her medical information with other treating providers. This authorization requirement has been removed.
These new and revised Medicare payment policies for Chronic Care Management offer new sources of revenue for practitioners caring for Medicare patients suffering from chronic diseases.
To view all of the 2017 CPT code revisions, download our complete guide to the 2017 CPT Code changes here. We've divided the new codes, revisions, and deletions into categories to make it easier for you to learn the new code changes before they are here.