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2022 Payment Rates for Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Other Virtual Care Programs.

CMS released the final rule in early November. Below are our key takeaways, and a chart that includes the 2022 codes, descriptions, and changes vs. 2021.


KEY TAKEAWAYS
  1. RPM reimbursement levels and CPT codes are unchanged (99453, 99454, 99457, 99458)
  2. Non-complex "standard whole care team counts" CCM (99490, 99439) reimbursement rates increase by ~30%
  3. Non-complex "QHP only counts" CCM (99491) gets an add-on code (99437) for an additional 30 minutes
  4. Principal Care Management (PCM) change from G codes to CPT codes and one code rate increases and another decreases. G2065 (whole care team counts PCM) is replaced by 99426 and increases by ~36%. G2064 (QHP only counts)is replaced by 99424 and decreases by ~25%
  5. PCM gets add-on codes for an additional 30 minutes beyond the initial 30 minutes (99427 whole care team, and 99425 QHP only)
  6. Remote Therapeutic Monitoring (RTM) is new, and on the same reimbursement level as RPM. The codes are (98975, 98976, 98977, 98980, 98981). However the virtual care services can ONLY be performed by a QHP (whereas RPM, CCM and PCM allow for the QHP to enlist a broader care team to support them working under their supervision)


CODE DESCRIPTIONS AND RATE TABLE

 

Code

CMS Description

2021 Rate*

2022 Rate*

% Change

2021 --> 2022

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)

 

$19.19 $22.07 15.01%
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]

 

$63.16 $60.80 -3.74%
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

 

$50.94 $49.04 -3.73%
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)

 

$41.17 $39.64 -3.73%
99091

 

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days)

 

$56.88 $54.75 -3.74%
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

 

$41.17 $52.74 28.09%
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

 

$37.69 $41.65 10.51%
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

 

$82.35 $80.95 -1.70%
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)

 

  $52.74  
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)

 

$38.73 $52.74 36.16%
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)

 

  $43.00  
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)

 

$90.37 $67.85 -24.91%
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)

 

  $52.74  
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

 

$91.77 $115.55 25.91%
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)

 

$43.97 $42.32 -3.74%
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

 

  $18.47  
98976

 

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

 

  $60.80  
98977

 

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

 

  $60.80  
98980

 

Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

 

  $49.38  
98981

 

Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (list separately in addition to code for primary procedure)

 

  $39.64  


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 2022 RPM Revenue Calculator is on THIS PAGE and the 2022 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! SCHEDULE A MEETING

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