New Codes, New Payment Opportunities for 2017


This year's changes include opportunities to get paid for some services that were previously not billable.

Fam Pract Manag. 2017 Jan-Feb;24(1):7-11.

Author disclosures: no relevant financial affiliations disclosed.

This year's CPT and Medicare updates include new and revised codes and billing rules that may enable you to get paid for some work you are already doing. Here is a summary of those opportunities and other changes most likely to affect family physicians.

Chronic care management

Several changes to the scope of service elements for chronic care management (CCM) clarify or simplify Medicare's billing requirements. For code 99490, “Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month … ,” as well as two additional codes discussed later in this article, the following changes apply:

  • The requirement to obtain the beneficiary's written agreement before providing CCM services has been removed; documenting in the medical record that the required information was explained and the beneficiary accepted or declined the services is sufficient,

  • The requirement that CCM may only be initiated during a Medicare annual wellness visit (AWV), initial preventive physical exam (IPPE, also known as a “Welcome to Medicare” visit), or face-to-face evaluation and management (E/M) visit applies only to new patients or those patients not seen within the last year rather than all patients,

  • The requirement for structured recording of patient information using certified electronic health record (EHR) technology no longer includes the creation of a structured clinical summary record,

  • A care plan must be provided to the patient, but the format is no longer specified,

  • Electronic sharing of the care plan with other providers has been redefined as electronically capturing care plan information and making it available in a “timely” manner, not necessarily 24/7, including via fax,

  • Access to 24/7 care has been redefined as providing patients and caregivers with a means to make timely contact with health care professionals in the practice to address all urgent care needs, not just those needs related to the patient's chronic conditions,

  • Communication with home- and community-based providers regarding the patient's psychosocial needs and functional deficits must be documented in the patient's medical record but not necessarily a certified EHR.

For CCM services that require more clinical staff time, more complex medical decision-making, and more substantive care planning than 99490, Medicare is extending payment to two CPT codes:

  • 99487, “Complex 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;

About the Authors

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Kent Moore is senior strategist for physician payment for the American Academy of Family Physicians (AAFP) and is a contributing editor to Family Practice Management....

Barbara Hays is coding and compliance strategist for the AAFP.

Author disclosures: no relevant financial affiliations disclosed.


Copyright © 2017 by the American Academy of Family Physicians.
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