2022 care management services codes to know - Medical Economics

There are new codes physicians need to know in the care management section of the Current Procedural Terminology codebook.

Question: Can you please tell us what the new codes are for principal care management and chronic care management?

Answer: There are three new codes in the care management section of the CPT codebook.

Care Management Services

Principal Care Management Services

New CPT codes have been added in 2022 to describe “Principal Care Management Services.” These codes are like chronic care management services in that the work involves the establishment, implementation, revision, and monitoring of a care plan for a patient. However, principal care management focuses on a single condition (rather than two or more). CPT code 99424 describes the first 30 minutes of a Principal Care Management service per calendar month provided by a physician or qualified healthcare professional. To capture each additional 30 minutes of service in addition to 99424, CPT code 99425 would be reported. CPT codes 99426 and 99427 also describe principal care management services, but for clinical staff time directed by a physician or qualified healthcare professional.

Starting this year, Medicare will accept CPT codes 99424, 99425, 99426 and 99427, and discontinue HCPCS codes G2064 and G2065.

Principal care management codes for 2022

Chronic Care Management

A new CPT code was also created effective January 1, 2022, to describe each additional 30 minutes of a chronic care management service performed by a physician or qualified healthcare professional. CPT code 99437 may be reported in addition to CPT code 99491.

Chronic care management codes for 2022

Note, there some times when it is inappropriate to bill these codes.

Do not bill these codes:

• When chronic care management is provided by medically directed staff only (use 99439, 99490)
• When less than 30 minutes of time is spent monthly,
• Twice in one month, or
• When the service time has been reported as transitional care management services (99495-99496).

Renee Dowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.

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