CMS bumps fees for CMS, elevates TCM

by Julia Kyles, CPC on Nov 6, 2019
CMS scaled back many of the proposed changes to chronic and transitional care management services (CMS), but a few made it to the final rule. Next year you’ll have an add-on code for chronic care management code provided by clinical staff and two codes for management of a single high-risk condition.
 
CMS also made adjustments to the fees that range from a loss of less than $2 to a gain of more than $20. That’s based on national calculations, your fees will vary based on your locality. The following chart provides a quick overview of what your revenue will look like in 2020. Watch upcoming issues of Part B News and other DecisionHealth publications for more details.
 
Code
Short descriptor
2019
2020
99490
Chronic care management services at least 20 minutes per calendar month
$42.17
$42.22
+G2058
Chronic care management services, each additional 20 minutes of clinical staff time
N/A
$37.89
99491
Chronic care management services by qualified health care professional, 30 minutes or more per calendar month
$83.97
$84.09
99487
Complex chronic care management services 60 minutes clinical staff time
$92.98
$92.39
+99489
Complex chronic care management services each additional 30 minutes clinical staff time
$46.49
$44.75
99495
Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge
$166.50
$187.67
99496
Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge
$234.97
$247.94
G2064
Comprehensive care management services for a single high-risk disease, e.g., Principal Care Management, at least 30 minutes of physician or other qualified health care professional time per calendar month
N/A
$92.03
G2065
Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
N/A
$39.70
By the way, here is the comparison for behavioral and psychiatric care management services.
99484
Care management services for behavioral health conditions, at least 20 minutes clinical staff time
$48.65
$48.00
99492
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month
$162.18
$156.99
99493
Subsequent psychiatric collaborative care management, first 60 minutes in subsequent month of behavioral health care manager activities
$129.38
$126.31
+99494
Initial or subsequent psychiatric collaborative care management, additional 30 minutes in the first calendar month
$67.03
$63.88
Source: PBN analysis of the Medicare 2020 final physician fee scheduleAddendum B
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