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2023 Payment Rates for Remote Patient Monitoring (RPM), Chronic Care Management (CCM), Principal Care Management (PCM), Remote Therapeutic Monitoring (RTM), and other Virtual Care Programs

CMS released the final rule in early November. Below are our key takeaways, and a chart that includes the 2023 codes and reimbursement rates. 

1bios offers the only software solution with support for every reimbursable care program, including dual enrollment optimization and the breadth of with and without device monitoring so you have a program fit for every patient. We also allow you to choose your engagement model, whether you want to utilize just our software system, or add on our Managed Device Service (MDS) for hassle free financing and device logistics, and/or our licensed clinical staff that will operate as an extension of your team for a completely turnkey solution.

Ask also about our Value Added Reseller (VAR)and referral programs if you are interested in bringing RPM, CCM and more to multiple practices and clients. 


KEY TAKEAWAYS
  1. RPM, CCM, RTM and PCM reimbursement levels and CPT codes are largely unchanged from 2022.  BHI codes supporting behavioral and mental health have increased up to 66% from 2022.
  2. New for 2023: RTM codes now support the delivery of monitoring and virtual care under general supervision of a Qualified Healthcare Provider (QHP i.e. a doctor, PA, RN in some cases). In 2022, the QHP had to perform 100% of the review time. Now, RTM can be operationalized in the same way as RPM, CCM and PCM such that an undue time burden is no longer placed on the QHP. 
  3. Certain virtual behavioral and mental health services (BHI) can now also be billed under general supervision and during the same month as chronic care management (CCM), transitional care management (TCM), and Remote Patient Monitoring (RPM) services, provided all requirements are met and time and effort are not double counted.


CODE DESCRIPTIONS AND RATE TABLE

 

Code

CMS Description

2023 Rate

Remote Patient Monitoring (RPM)
99453

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment)

$19.32
99454

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days) [minimum 16 readings each 30 days]

$50.15
99457

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.

$48.80
99458

 

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (list separately in addition to code for primary procedure)

 

$39.65
99091

 

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) provided personally by a physician or other QHP, a minimum of 30 minutes of time during the month.

 

$54.22
Chronic Care Management (CCM)
99490

 

Chronic Care Management (CCM) services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; Comprehensive care plan established, implemented, revised, or monitored

 

$62.69
99439

 

Chronic Care Management (CCM) services, each additional 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

 

$47.44
G0511

Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month

$79.26
99491

 

Chronic Care Management (CCM), provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored

 

$85.06
99437

 

Chronic Care Management (CCM) services each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

 

$59.98
Principal Care Management
99426

 

Principal Care Management (PCM), for a single high-risk disease first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month (replaces G2065)

 

$61.34
99427

 

Principal Care Management (PCM) services, for a single high-risk disease each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

 

$47.44
99424

 

Principal Care Management (PCM) services for a single high-risk disease first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (replaces G2064)

 

$81.33
99425

 

Principal Care Management (PCM) services for a single high-risk disease each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

 

$58.29
Complex Chronic Care Management (CCCM)
99487

 

Complex chronic care management (CCCM) services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months,
or until the death of the patient, chronic conditions place the patient at significant risk of death,
acute exacerbation/decompensation, or functional decline, comprehensive care plan established,
implemented, revised, or monitored, moderate or high complexity medical decision making; first
60 minutes of clinical staff time directed by a physician or other qualified health care
professional, per calendar month

 

$133.18
99489

 

Complex chronic care management (CCCM) services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

 

$70.49
Remote Therapeutic Monitoring (RTM)
98975

 

Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment

 

$19.32
98976

 

Remote therapeutic monitoring (e.g., respiratory system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor respiratory system, each 30 days [16 readings minimum each 30 days]

 

$50.15
98977

 

Remote therapeutic monitoring (e.g., musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days [16 readings minimum each 30 days]

 

$50.15
98980

 

Remote therapeutic monitoring treatment management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, requiring at least one interactive communication with the patient/caregiver during the calendar month

 

$48.80
98981

 

Remote therapeutic monitoring treatment management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure)

 

$39.65

Behavioral Health Integration (BHI)

99484

 

BHI services, at least 20 minutes of clinical staff time (does not require specialized Behavioral Health Care Manager) per calendar month, may be delivered under general supervision of a physician or other qualified health care professional, with the following required elements: registry for time and documentation recording and documentation, initial assessment and follow-up utilizing rating scales (e.g. PHQ-9), coordinating care as needed under the mental health umbrella. 

 

$43.04
98492

 

Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, under general supervision of the treating physician or other qualified health care professional. Includes time-tracking and documentation in registry, initial assessment including rating scales (e.g. PHQ-9), assignment of treatment plan.

 

$150.80

99493

 

Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of Behavioral Health Care Manager activities, in consultation with a psychiatric consultant, and under general supervision of the treating physician or other qualified health care professional, with the following required elements: registry for time and documentation recording and documentation, initial assessment and follow up utilizing rating scales (e.g. PHQ-9), coordinating care as needed under the mental health umbrella. 

 

$142.67
99494

 

Subsequent psychiatric collaborative care management, each additional 30 minutes in a subsequent month of Behavioral Health Care Manager activities (beyond the 99493 60 minutes), in consultation with a psychiatric consultant, under the general supervision of the treating physician or other qualified health care professional, with the following required elements: registry for time and documentation recording and documentation, initial assessment and follow up utilizing rating scales (e.g. PHQ-9), coordinating care as needed under the mental health umbrella. 

 

$57.95


Note we've updated our CCM and RPM revenue calculators with the new rates so you can use those to project your eligible patients and potential program revenues for 2022.  The 2023 RPM Revenue Calculator is on THIS PAGE and the 2023 CCM Revenue Calculator is on THIS PAGE. (We're also happy to provide full revenue and cost models, just email sales@1bioshealth.com. Or, book a meeting with us below.)

If you're ready to discuss the best approach to start or improve RPM, CCM, and other virtual care programs for your organization, book a virtual meeting with us today!

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