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Every year the Centers for Medicare and Medicaid Services announce changes to how care providers are to be reimbursed for services provided during the upcoming year. We selected the most impactful changes and updates physicians should take note of and are excited about the improvements care providers are to see starting January 1, 2022.



  1. New Remote Therapeutic Monitoring category created with 5 new CPT codes

The CMS introduced a new set of remote care related CPT codes under a new category: Remote Therapeutic Monitoring.

Unlike the Remote Physiologic Monitoring code set categorized as Evaluation and Management (“E/M”) codes in the CPT Manual, the five codes finalized for Remote Therapeutic Monitoring are general Medicine codes, billable by practitioners who are not eligible, in addition to providers who are eligible to bill E/M services.

Initial Set-up and Patient Education: CPT code 98975 (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment)

Supply of Device for Monitoring Respiratory System: CPT code 98976 (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days)

Supply of Device for Monitoring Musculoskeletal System: CPT code 98977 (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days)

Monitoring/Treatment Management Services, first 20 minutes: CPT code 98980 (Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes)

Monitoring/Treatment Management Services, each additional 20 minutes: CPT code 98981 (Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure))

These new codes currently cover 2 health conditions: respiratory issues and musculoskeletal issues and are designed to cover services associated with tracking therapy and medication adherence and response. Unlike the RPM codes, RTM services are available to Qualified Health Care Practitioners (“QHCPs”) who are not able to independently order and bill for E/Mvservices. This is great news for physical therapists, occupational therapists, dietitians, clinical psychologists, and other QHCPs who are eligible to bill the general Medicine codes. Further benefits of these codes include the lack of mandatory automatic data transmission as for the RPM codes meaning, these can be patient self-reported data using a FDA-approved device.


  1. More new reimbursement codes for CCM and PCM and increase in reimbursements for existing payments in those categories

In the Final Medicare Physician Fee Schedule (“MPFS”) for 2022 (the “Final Rule”) issued on November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) added five new CPT codes in the categories of Chronic Care Management (“CCM”) and Principal Care Management (“PCM”) and increased reimbursement for already existing codes in the same categories.

New CPT code 99437 is an add-on code for existing CPT 99491 code and pays for CCM services each additional 30 minutes by a physician or other qualified health care professional, per calendar month.

In the Final Rule, CMS added the below four new PCM codes to replace the two previous PCM codes G2064 and G2065. The PCM codes now mirror the existing CCM code structure, with initial and add-on codes for services personally provided by physicians and QHCPs as well as services provided by clinical staff. PCM reimbursements are for patients with a single chronic condition. CPT 99424 reimburses the first 30 mins of care provider personally by the physician or other QHCP per calendar month. CPT 99425 coves additional 30 mins of care. CPT 99426 reimburses the first 30 mins of care provider personally by clinical staff and additional 30 mins of care are billable by its add-on code 99427.

Chronic care management in particular has been a significant increase in reimbursements for 2022, with CPT 99490 RVU rising from 0.61 in 2021 to 1.0 in 2022 and 99439 from 0.54 to 0.70, 99487 going from 1.0 to 1.81 and its add-on code doubling RVU for 2022.

  1. Lara Health customers to enjoy a new care module adding extra $800-1000 per eligible patient in new, additional reimbursements

Many independent medical practices are still recovering from the financial and staffing impacts of 2020 and 2021, brought by the COVID-19 pandemic and the lack of virtual and digital tools that would allow physicians to care for their patients. Lara Health is changing that with our automation-driven platform that brings multiple care models and digital tools to medical practices into one turnkey solution. We thrive to continue expanding our help and product and are excited to announce we have more tools for care optimization and reimbursements lined up for 2022. Practices working with Lara Health will have the opportunity to offer their patients specialty care triage services as well as advanced care initiatives, starting with our cardiology module. 


Schedule a quick call or a demo to see how we are making patient care easier and more rewarding for all stakeholders and how our new care modules can triple your reimbursement for each eligible patient with us.

 

  1. More opportunities to boost reimbursements for primary care providers in 2022

CMS has increased physician payments for vaccine administration and chronic care management, is implementing a long overdue update to clinical labor pricing and is recognizing the importance of telehealth services beyond the public health emergency (PHE). 


CMS said that the Medicare Part B rates physicians receive for each influenza, pneumococcal and hepatitis B vaccine administered will increase from approximately $17 to $30.


CMS also finalized its proposal to allow rural health clinics and federally qualified health centers to bill for chronic care management services, including transitional care management, that are delivered “for the same beneficiary during the same service period, provided all requirements for billing each code are met.”


The final rule also includes the first update in nearly 20 years to clinical labor rates that are used to determine practice expenses, CMS said. Many health care professionals will see increases in payment over the next 4 years for each minute they conduct tasks.

Significant strides were also made in telehealth, with CMS’s final rule allowing for counseling, therapy and treatment of substance use disorders and services offered through opioid treatment programs to be conducted via audio-only telephone calls. In addition, and for the first time outside of the COVID-19 public health emergency, Medicare will reimburse mental health visits that are conducted by rural health clinics and federally qualified health centers through telecommunications technology such as audio-only telephone calls, according to CMS.



  1. Physician assistants to bill independently from the PCP

The CMS permanently authorized PAs to receive direct payment from the Medicare program starting January 2022. Currently, payment for services provided by PAs is required to be made to the PA’s employer. The inability to be paid directly hindered PAs from fully participating in certain practice, employment, and ownership arrangements, prevented them from reassigning their payments in a manner similar to physicians and APRNs, and created additional administrative barriers to hiring and utilizing PAs.

Similar to most physicians and nurse practitioners (NPs) who already have access to direct payment, the majority of PAs will maintain their current W-2 employment relationships with reimbursement for their services continuing to flow to their employers. 

PAs who choose to receive payment directly from Medicare for their services will be able to:

  • Form medical corporations/practices with other PAs in the same specialty
  • Seek work as self-employed independent contractors
  • Reassign Medicare payment rights to any employer, facility, or billing agent
  • Receive reimbursement for “carved out” services when working in a Rural Health Clinic (“RHC”) or Federally Qualified Health Center (“FQHC”)



Schedule a quick call or a demo to see how we are making patient care easier and more rewarding for all stakeholders and how our new care modules can triple your reimbursement for each eligible patient with us.