In my previous article, we covered 5 proven ways to use 2021/2022 CPT coding changes to leverage your time, team, and outsourcing capabilities to grow your practice and improve patient outcomes.

In this article, we’ll dive into specific examples of 2021/2022 CPT coding changes that can help you expand your practice and billables in 2022 and beyond.

The first step: Get familiar with the 2021 coding changes

For a full list of 2021 CPT coding changes, see 2021 AMA Coding and Guideline Changes.

Here are some examples of CPT codes and categories to be familiar with for billing telemedicine, coaching, and group visits.
Taxonomy Codes: CMS has expanded incident-to billing to include other staff, including board-certified health coaches. As of April 1, 2021, board-certified health coaches now have their own taxonomy code. The health and wellness coach taxonomy code is 71400000X. Your health coaches, either in-office or outsourced, should have their own NPI number, which will be important as things progress for billing purposes.

Medical decision-making. When enrolling patients in a telemedicine group program to address a disease state (using the appropriate ICD-10 diagnosis code), two common E/M CPT codes to consider in this category are 99213 and 99214. You can view all the details from the AMA’s release here, but both these codes include same-day face-to-face or non-face-to-face-time with the physician or other provider.

Chronic care management (CCM). Chronic care management codes allow coaches and other care providers to see patients virtually with two or more chronic conditions on a one-to-one basis. CCM CPT 99490 is the most common billing code, can be used every month, and reimburses at a national average of $40-$50 per patient. Twenty minutes of care provided by the doctor, qualified health care professional or health coach (under provider supervision) are required. CCM CPT 99439 can also be added on to 99490 for each additional 20 minutes of time. CCM CPT 99491 can also be used monthly and requires 30 minutes of physician time.

Behavioral modification codes. As mentioned above, individual and group visits with health coaches or other non-physician qualified health care professionals (NPQHCs) that are focused on addressing a type of disease or ICD-10 diagnosis fall under the umbrella of behavioral modification strategies. A couple of examples of lifestyle behavior modification CPT codes are: 96156 and 96158 for a one-on-one assessment/questionnaire.

Remote patient monitoring (RPM). There is an opportunity for additional revenue for services performed remotely (outside the office) through remote patient monitoring of biometrics like blood glucose level, blood pressure, weight, etc. Patients with acute or chronic conditions are eligible for these services.

The most important changes in 2021 for RPM billing include an expansion of CPT codes for greater billing potential, what defines remote patient monitoring, and the types of health care professionals who can provide these services. New reimbursements are set up to cover time, equipment, and resources, as well as management and interactive communication.

Some important RPM CPT codes to be aware of in 2021 are 99453, 99454, 99457, 99458, which were created in 2020 for remote physiologic monitoring. 99453 is the remote monitoring of physiologic parameters, set up and patient education on use of equipment, initial, billed one time: $20.00. 99454 is remote monitoring of daily recordings or alerts, billed every 30 days: $63.00. 99457 is for the first 20 minutes of RPM management services via interactive communication provided by physician, clinical staff or QHP in a calendar month: $51.00. And 99458 is for each additional 20 minutes: $41.00. Note: there are minimum adherence requirements, so please see appropriate CMS documentation for details.

When you put all of these factors together, it’s clear that if you’re well organized, it is possible to deliver a very high standard of care — and get paid well for it — in the payer environment.

Next step: Stay abreast of 2022 coding changes

The AMA has already released some information on what to expect for 2022 CPT coding changes. (Spoiler alert: It’s good news for telemedicine providers.)

Per their September 7, 2021, press release: AMA releases 2022 CPT code set: “Other important additions to the 2022 CPT code set to respond to the fast pace of innovation in digital medicine services that can improve health care access and enhance outcomes for patients across the country.”

Some highlights of upcoming 2022 CPT coding changes:

Chronic care management/CCM CPT codes are increasing: CPT CCM codes 99490 and 99439, which include 20 minutes of clinical staff time, are increasing 50 percent on January 2, 2022. In dollars and cents, that means CPT 99490 is increasing from $41.17 to $63.47/pt/mo and 99439 from $37.69 to $49.36/pt/mo. That’s a potential increase of $63.00+ per patient per month for those doing chronic care management.

Remote patient monitoring is gaining the support of remote therapeutic monitoring:

Remote monitoring of vitals is helpful in maintaining a patient’s health, but remote therapeutic monitoring can also improve their health long-term. Remote therapeutic monitoring is being expanded via the creation of five new CPT codes: 98975, 98976, 98977, 98980, 98981.

Principal care management is expanding for chronic care management: new CPT codes have been created for principal care management of chronic conditions: 99424, 99425, 99426, 99427. These new codes allow physicians and other practitioners to report care management services for patients with a single (not 2 to 3, or more) complex chronic condition.

This shows us that remote chronic care management spearheaded by non-physician providers (including coaches) has successfully expanded the umbrella to cover patients with fewer chronic conditions. Plus, when patients know they can get high-quality and consistent care (and coverage) for a single condition, they’ll be more likely to seek help earlier in the disease process.

How can providers best prepare for this inevitable shift?

There’s a new best practice emerging, one that lets you deliver a high standard of care today but that well-prepares you for a shift to value. We’ve been talking about it throughout this article series in terms of doing more with less and making the system work for you: it’s group coaching combined with remote patient monitoring. And, based on the coding changes and expanded reimbursements, the data show that patient outcomes are vastly improving under this new model.

The conclusion: It’s time to expand and modernize your practice by offering group coaching services and having your patients’ commercial insurance, Medicare, or workers comp pay the bill.

James Maskell is a health care executive.

Image credit: Shutterstock.com