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In calendar year (CY) 2020 Final Rule, Medicare made significant updates to the Care Management (CM) Current Procedural Terminology (CPT) codes and related services. This coding corner focuses on the changes from the following CM categories:
Transitional Care Management (TCM) Services: These services are for a new or established patients whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care from an inpatient hospital, partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility to the patient’s community setting (home, domiciliary, rest home, or assisted living). TCM services commence upon the date of discharge and continue for the next 29 days. Refer to Table 1 for code descriptions and changes for CY 2020.
Chronic Care Management (CCM) Services: These services are provided when the medical and/or psychosocial needs of the patient require establishing, implementing, revising, or monitoring the care plan. Patients who receive CCM services must have at least two or more serious chronic or episodic health conditions that are expected to last at least 12 months, or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline. Refer to Table 3 for code descriptions and changes for CY 2020.
Principal Care Management (PCM) Services (NEW): These services are for patients with one serious chronic condition that is typically expected to last between three months and a year or until the death of the patient. This condition may have led to a recent hospitalization, and/or placed the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. Refer to Table 4 for code descriptions for CY 2020.
TABLE 1 – TCM Services
TABLE 2 – Effective January 1, 2020, These Codes May be Billed Concurrently with TCM Services
Table 3 – CCM Services
Table 4 – PCM Services
CY 2020 CPT Professional Edition Coding Manual
CY 2020 Medicare Physician Fee Schedule (MPFS) Final Rule: Care Management Services