2015 Physician Fee Schedule Includes New Code for Chronic Care Management

by | Published on Jan 30, 2015 | Medical Coding

Physician Fee Schedule
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The Centers for Medicare & Medicaid Services (CMS) recently released the proposed physician fee schedule for the year 2015. This fee schedule includes a new code for chronic care management (CCM). It also features projected pay cuts required by the sustainable growth rate (SGR) formula used to determine physician payment. Medicare would begin to pay physicians $41.92 that can be billed not more than once per month for managing patients with two or more chronic conditions outside of face-to-face office visits.

Earlier (in the year 2013), CMS had authorized a new medical billing code for chronic-care management to compensate physicians. This code covered tasks such as referring patients to colleagues, developing a detailed home care plan and functioning with home care agencies that are not correctly reimbursed under the existing evaluation and management payment codes. The new billing code was scheduled to take effect in 2015, but CMS failed to assign a dollar amount to the same.

Physicians would begin the billing process for chronic care management using a new G code. Generally, elderly or disabled patients suffering from complex health disorders require the medical attention by a primary-care physician. In most cases, 20 minutes of chronic care services for at least 30 days may be needed for a patient whose multiple chronic conditions are expected to last for a long time or until death. So, chronic care management services must be made available on a 24/7 basis. Clinical staff can offer services at the midnight hour on an “incident-to” billing basis without any direct supervision.

The new billing codes for chronic care recognizes the relative value of additional administrative work that happens outside the exam room. In the current physician fee schedule for 2015, CMS is proposing to require that physicians use certified electronic health record technology (EHR).

The billing code for chronic care management was proposed in an attempt to support those primary care physicians who are struggling financially. Another provision in this fee schedule recommends stoppage of set–fee payments to surgeons for procedures that include postoperative services – think office visits (during 10- day and 90-day-global periods). Instead, a new proposal to separately bill postoperative services on a piecemeal basis during these time-frames is recommended.

CMS also proposes to expand the list of reimbursable services provided via telemedicine. The list would now include psychoanalysis, psychotherapy, annual wellness visits and prolonged evaluation and management services. This change is expected to improve patient access to healthcare services in rural areas.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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