Podiatry Coding & Billing Alert

CPT® 2022:

Adopt New Principal Care Management E/M Codes Before 2022 Rolls Around

Code 99211 will be revised in 2022.

When CPT® 2022 becomes effective on Jan. 1, 2022, you will not see any new podiatry-specific codes. However, you will get several new evaluation and management (E/M) additions and revisions.

Keep your podiatry claims in tip-top shape by staying on top of the following E/M updates you will see next year.

Read on to learn more.

Discover New Chronic Care, Principal Care Management Codes

You will receive a new chronic care management (CCM) code in 2022: +99437 (Chronic care management 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 that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline …)

Additionally, you will gain several new principal care management service codes. They are as follows:

  • 99424 (Principal care management services, for a single high-risk disease, with the following required elements:
    • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/ decompensation, functional decline, or death,
    • the condition requires development, monitoring, or revision of disease-specific care plan … first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.)
  • +99425 (Principal care management services, for a single high-risk disease, with the following required elements:
    • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/ decompensation, functional decline, or death,
    • the condition requires development, monitoring, or revision of disease-specific care plan … 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))
  • 99426 (Principal care management services, for a single high-risk disease, with the following required elements:
    • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/ decompensation, functional decline, or death,
    • the condition requires development, monitoring, or revision of disease-specific care plan …first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month.)
  • +99427 (Principal care management services, for a single high-risk disease, with the following required elements:
    • one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/ decompensation, functional decline, or death,
    • the condition requires development, monitoring, or revision of disease-specific care plan … 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))

Don’t miss: Code +99425 is an add-on code you can use with primary code 99424. Also, code +99427 is an add-on code you can use with primary code 99426.

Don’t Miss These E/M Revisions

You will also see numerous E/M revisions in 2022.

For example, the descriptor for code 99211 will gain some changes: 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.) (Emphasis added.)

You will also seem some changes to code 99491 (Chronic care management services, 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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
  • comprehensive care plan established, implemented, revised, or monitored; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.) (Emphasis added).

Also, codes 99490 and 99487 will receive a small revision. The word “that” will be added to the code descriptors. For example, 99490 will now be (Chronic care management 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 that place the patient at significant risk…). (Emphasis added.)


Other Articles in this issue of

Podiatry Coding & Billing Alert

View All