Jan 10 / Jessica Sinclair

3 Things to Look Forward to in 2022 for CCM and PCM

How will your pharmacist-led services change in 2022?

The past year has been full of unexpected events and healthcare professionals on the front lines have been pivoting to meet the needs of the community and the public health emergency. The Centers for Medicare & Medicaid Services (CMS) has also been busy responding to the feedback from stakeholders on how to best serve Medicare beneficiaries in 2022. While the Final Rule has clarified some questions surrounding collaborative clinical services, some questions still remain unanswered, such as what will become of the new service, Remote Therapeutic Monitoring (RTM), and whether pharmacists can be involved. What we do know is that 2022 is full of some exciting changes for pharmacists and pharmacy teams involved in non-face-to-face services and here are some of the things we can look forward to:

1. Increases in Payment for Chronic Care Management (CCM) 

For those collaborating with providers to offer CCM services, you can expect to see a significant increase in payment this year! Payment for CCM services has been through several refinements since the coding was first introduced. CMS commented on the importance of ensuring access to crucial services, such as CCM, for Medicare beneficiaries and they believe these payment updates will help support continued provision of these services. 

2. Increases in Payment for Principal Care Management (PCM)

Similar to what we’ll see with CCM, PCM payments will also increase this year! We will see an increase in payment for PCM codes across the board. While the PCM table below focuses on the codes pertinent to clinical staff, there are additional codes for physician and other qualified health care professional time if this time is personally accumulated by the provider. Pharmacists fall under the clinical staff category and can contribute to PCM services for specialists and other providers offering PCM.

3. New Codes for Principal Care Management (PCM) 

In 2022, we will see two new codes introduced for PCM: 99427 and 99425. 99427 is the add-on code for PCM for clinical staff time and 99425 is the add-on code for physician or QHP time. Prior to the addition of these codes, practices were limited to billing for 30 minutes of time for PCM services. Any additional time dedicated to the care planning and management of patients enrolled in PCM was not billable. These changes will help practices provide the necessary support for patients with high-risk conditions that may put them at an increased risk for hospitalization. 

What can I do to help practices prepare for these changes?

One of the first things you’ll want to do with your collaborating practices is make sure that they’ve updated their fee schedules to reflect these increases in payment. If they’re billing below the updated payment amounts, they will not benefit from these payment increases. 

If you are not working with providers yet but want to share the opportunity for increased payment, consider learning more about how to collaborate with local providers in your area and help them assess the opportunities at their practice. 

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