2020 CMS Added Additional CPT Codes For Specialist And PCP To Bill For Care Management

2020 CMS Added Additional CPT Codes for Specialist and PCP to bill for Care Management

CMS has expanded the scope of Care Management services in 2020 to provide additional billing codes for the following:

  • Chronic Care Management (CCM) services
  • Principal Care Management Services (PCM) primarily for specialists
  • Chronic care remote physiologic monitoring (RPM)

Code G2058 ($37.89) is for every 20 minute interval beyond the initial 20 minute interval to bill CPT Code 99490.

CPT 99490 is $42.23, while each add-on 20 minute code G2058 (up to two) pays $37.89. Thus, total reimbursement for 1 hour or more of non-complex CCM services is $118.01.

Specialists can bill for a single serious chronic condition, Principal Care Management Services (PCM) CPT Code G2064 and G2065, even if a PCP is billing for CCM. PCPs can bill for a single serious chronic condition, if not able to bill for CCM. I am not sure if you decided to stay in the OCM model for 2020 with the shared risk/ savings but we could provide care management services for the oncologists under PCM, too.

Principal Care Management (CPT G2065) for 30 minutes of clinical staff time = $ 42.23

Additionally,  they have expanded to allow Care Management firms to provide chronic care remote physiologic monitoring (RPM) services, increased the payment for these services and have allowed them to be billed along with CCM and PCM.

Remote Physiologic Monitoring (RPM):  99457($51.54) and 99458 code while each add-on code (up to 2) pays $42.23 Thus, total reimbursement for an hour or more of RPM services is $136.09. RPM Can be done under general supervision in 2020.

For more information or to see how CareVitality Can Assist Your Organization  please contact us (800) 376-0212 or contact@carevitality.com.

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