Medicare Proposes New Codes and More Money for Care Management Services in 2022 - PYA

Providers presently furnishing ambulatory care management services (including chronic care management and remote monitoring) for Medicare beneficiaries as well as those considering these services should take a careful look at the 2022 Medicare Physician Fee Schedule Proposed Rule. The Centers for Medicare & Medicaid Services (CMS) proposes to complete the code sets for care management services. CMS proposes increasing the work values for the care management codes, which would result in a significant increase in Medicare reimbursement for these services in 2022. The following table lists the current 2021 national payment rate (non-facility) compared to the proposed 2022 national payment rate (non-facility) by CPT code.

Finally, CMS seeks comment on whether Medicare should provide additional reimbursement to incentivize providers to furnish care management services for beneficiaries with chronic pain. Noting that chronic pain management “could potentially be effective in preventing or reducing the need for acute services…and reduce the need for treatment for mental disorders,” CMS acknowledges that “[c]urrent Medicare payment methodologies such as [CCM] support chronic disease management, though may not provide adequate payment to health care providers or systems to holistically care for beneficiaries with chronic pain; we believe the complexity and resources required for safe and effective pain management may not be adequately captured and paid through these codes.”