Pain Management Coding Alert

Question: What is the final rule from CMS on the payment rate change for care management codes?

Maine Subscriber 

Answer: Along with the proposal for separate payment for chronic care management (CCM) in 2015, CMS proposes a payment rate of $41.92 for the 99487-99489 (Complex chronic care coordination services; …) codes. These codes can be billed no more than once per month, per qualified patient.

Last year’s final rule from CMS created a policy to make separate payment for non-face-to-face chronic care management services for Medicare beneficiaries who have multiple, significant chronic conditions (two or more). Chronic care management services include regular development and revision of a plan of care, communication with other treating health professionals, and medication management.

This year’s proposed rule addresses three aspects of CCM services: 

• “We [CMS] propose a payment rate of $41.92 for the code that can be billed no more frequently than once per month per qualified patient. 
• “We also propose to allow greater flexibility in the supervision of clinical staff providing CCM services. 

“Finally, we are not proposing to establish separate standards that practitioners and practices furnishing this service would have to meet, as we had indicated last year. Upon further review, we believe the scope of service requirements for CCM, most of which were finalized last year, would be sufficient for practitioners to deliver CCM. We are proposing one additional requirement – standards for electronic health records”

Read the entire proposal in the CMS Fact Sheet at www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-07-03-1.html.