The Issue -- The Case Management Society of America (CMSA) continues to advocate for a change in Current Procedural Terminology (CPT) code currently in place in the 2008 Physician Fee Schedule. While the current schedule includes codes related to the delivery of case management services, these codes are a Status N, which means they are non-payable by Medicare. CMSA is working with the Centers for Medicare and Medicaid Services (CMS) in support of funding the reimbursement of these codes.
As an essential part of the health care 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 CPT codes were 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
The Impact -- All six of these new codes 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.
The Solution -- CMSA believes that by requesting funding support for these six 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.
Resources – For more information on the issue of CPT coding for case management, please review the attached letter CMSA sent to CMS regarding CPT coding changes.