The Case Management Society of America (CMSA) wishes to inform you of an important initiative pertaining to Current Procedural Terminology (CPT) code changes currently in place for the 2008 Physician Fee Schedule. In addition, we urgently request you submit comments to Centers for Medicare and Medicaid Services (CMS) in support of funding the reimbursement of these new codes.
CMSA is the leading professional organization devoted to case/care management. Case/care management is a "collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's healthcare needs through communication and available resources" (CMSA, 2002). As an essential part of the healthcare team, case managers routinely work directly with patients in support of medical management objectives and health care coordination. The processes of health adherence assessment, education and adherence monitoring are well within the scope of case/care management practice.
Professional case/care managers perform these responsibilities as a core function of their jobs. As licensed professionals, case/care managers use proven techniques (e.g., health literacy assessment, readiness to change) in working with patients, caregivers, and fellow healthcare professionals toward measurable improvement in health status.
New codes have been approved for 2008 related to telephone evaluation and management services provided by a physician:
- 99441: Telephone evaluation and management services provided by a physician to an established patient, parent or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion.
- 99442: ... 11-20 minutes of medical discussion.
- 99443: ... 21-30 minutes of medical discussion.
Furthermore, another three non-physician codes were issued for non face to face telephone services:
- 98966: Telephone assessment and management services provided by a qualified non-physician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management services or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion.
- 98967: ... 11-20 minutes of medical discussion
- 98968: ... 21-30 minutes of medical discussion
An interim final rule was released November 1, 2007 for the 2008 Physician Fee Schedule. All of the six (6) new codes identified above are a Status N, which means they are non-payable by Medicare. However, they do have Relative Value Units associated with each, meaning that private payers may cover them.
CMSA believes that by requesting funding support for these six (6) codes, providers will be able to integrate case/care managers support of the Medical Home concept, such as the Medicare Medical Home Demonstration (MMHD), pay for performance programs, and various collaborative models of care which CMSA and other regulatory agencies are discussing.
CMSA seeks your assistance in submitting comments on the CMS website in support of a change of payable status set by Medicare. CMSA is providing you a
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