A dramatic change in CCM reimbursement rates kicked into effect January 1st

January 1, 2022 /

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In case you have not yet already heard, the Final Medicare Physician Fee Schedule (MPFS) for 2022 contains groundbreaking changes that benefit practices taking part in a Chronic Care Management (CCM) program. This historic bump in Medicare’s reimbursement rates affects any practice billing CPT codes 99490, 99439, 99487, and 99489. To be more clear, Traditional practices’ average reimbursement rate jumps by more than $20, while FQHCs and RHCs increase over $16 per patient, per month. We estimate that on average, practices can expect to see a revenue increase of 52% compared to 2021. Medicare’s CMS gift for 2022 is clear – and it’s Chronic Care Management.

But wait, why are the Centers for Medicare & Medicaid Services (CMS) increasing CCM reimbursements for 2022? And why are there new Current Procedural Terminology (CPT) codes? A recent RVS Update Committee (RUC) survey revealed how care management services are undervalued and over 70% of their recommendations are being put into effect. Additional reimbursements and new CPT codes show that CMS recognizes the value of CCM; and its commitment to healthcare providers that participate in care management services.

It’s time to get your program up and running. Learn how a partner like ChartSpan can help you maximize value for your patients and generate the most revenue for your practice. All without the hassle or risk of doing it on your own.

By the numbers: 2022 Average Reimbursement Rate Increase

CodesReimbursement Increase20222021
CPT 99490+$23.61$65.61$42
G0511+$16.02$81.26$65.24
*(Per Patient, Per Month) Actual reimbursement varies slightly by region.

Article Updated January 3rd, 2022

Even Higher CCM Rates for 2022!

Medicare cuts averted. Thanks to a bill signed into law by President Joe Biden on December 10th, 2021 – FQHC, RHC, and Traditional practices will see an extra 2% bump in their average reimbursement rates than we originally published in this article.
Source: Beckers Hospital Review

Key Takeaways & Frequently Asked Questions

Why is CMS increasing CCM reimbursements for 2022?

The results of a recent RVS Update Committee (RUC) survey reveal how care management services are undervalued. The increased reimbursements and new CPT codes reveal how CMS recognizes the value of CCM and its commitment to healthcare providers that participate in care management services. Medicare sees the results regarding a reduction in overall healthcare spending, improved care for patients, and revenue generated for providers.

We don’t have a CCM program in place. Where do we start?

Learn more about CCM here or connect with a guide here.

Will these changes impact Federally Qualified Health Centers (FQHCs) & Rural Health Centers (RHCs)?

Yes!

What are the special codes for FQHC & RHC CCM?

G0511

What are the biggest obstacles to care management success?

The operational complexity of the program and the necessary requirements to operate at scale. One must be able to manage enrollment, patient churn, patient satisfaction, and set clear expectations with the patient. If it was easy everyone would be doing it!

Data Sources:

  • 2022 Physican Fee Schedule Final Rule (pdf)
    • Page 358 – (38) Principal Care Management and Chronic Care Management (CPT codes 99490, 99439, 99491, 99437, 99487, 99489, 99424, 99425, 99426, and 99427). 
    • Page 363 – Table 19: TABLE 19: CY 2022 CCM/CCCM/PCM Values
  • CY 2022 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Final Rule Summary (pdf)

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