New 2022 Rates Position CMS’ Chronic Care Programs Are Ripe for Increased Revenue, Improved Outcomes

New 2022 Rates Position CMS’ Chronic Care Programs Are Ripe for Increased Revenue, Improved Outcomes

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If you’ve implemented chronic care management (CCM) or remote physiologic monitoring (RPM, a.k.a. remote patient monitoring) in your practice, you know that they generate new streams of revenue while allocating more time to take better care of your patients—with potentially life-saving results. In fact, Medicare is so confident that these programs will pay off that it has dramatically increased CCM overall reimbursement rates for 2022. So, if you’re not already on board, here’s what has changed and why you’ll want to seriously consider implementing one or both programs this year.

Chronic Care Management Reimbursements are Generous 

CCM will see the most remarkable change in 2022, with reimbursement increases as high as 60% (see chart below). CMS increased reimbursement rates generating substantial revenue for physician practices.*  Let’s put that into context: 

2022 CCM REIMBURSEMENT RATES 

CPT/HCPCS Codes

2021 Reimbursement

2022 Reimbursement

%Change

Basic CCM

99490

$42

$62

48%

99439

$38

$61

60%

Complex CCM

99487

$93

$130

40%

99489

$45

$69

53%

An easy way to gauge potential revenues for your practice is the 40-40-20 rule: 40% of your CCM patients will require 20 minutes of time, 40% will require 40 minutes of time, and 20% will require an hour or more, per month.

Remote Patient Monitoring CMS Reimbursement Adjusted

CMS adjusted pricing downward for their reimbursement model for RPM CPT codes. Despite these lower rates (see chart below), RPM is still a beneficial program to include in your practice both from the perspective of improved health for your chronic care patients and your bottom line. 

2022 RPM REIMBURSEMENT RATES 

CPT Codes

Remote Physiologic Management

2021 Reimbursement

2022 Reimbursement

%Change

99453

$20

$18

-10%

99454

$64

$55

-14%

99457

$52

$49

-6%

99458

$42

$40

-5%

Despite handsome CMS reimbursement rates for chronic disease management, only 5% of the $40 billion CMS incentive dollars have been disbursed to physician practices around the country. That’s because many practices  believe there is excessive investment of their time and technology required to get a chronic disease management program implemented. This is where PharmD Live can help. We provide turn-key CCM and RPM solutions with personalized chronic care coordination and medication management through board-certified pharmacists who function as an extension of your team. We charge no upfront costs or monthly subscription fees. We are paid based on your CMS monthly reimbursement.

Contact us today to determine how much additional annual income your practice can earn.

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