The New Incremental Add-On Code for Chronic Care Management (Starting in 2020)

The New Incremental Add-On Code for Chronic Care Management (Starting in 2020)

by Sam Balkhanian

On November 1, 2019, The Centers for Medicare and Medicaid Services released their infamous “CMS Final Rule” for 2020. The final rule includes a new incremental reimbursement for Chronic Care Management, HCPCS – G2058.

This new add–on code reimburses practices for each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

This code must be billed in conjunction with CPT code 99490 and cannot be billed in the same calendar month as CPT codes 99487-, 99489, and 99491. The code is limited to a maximum of two times within the calendar month service period. CMS created this new add-on to more accurately capture resource involvement and reflect more accurate payments for non-complex chronic care management services.

What does this mean? Let me give you an example. If a practice spends 40 minutes of non-face to face clinical time on a patient, in a calendar month, they can only bill for 20 minutes of that time, CPT Code 99490. The remaining 20 minutes of work performed by the doctor is not reimbursed.  With this new add-on code, this does not have to be the case.

Begining in 2020, providers can bill for additional 20 minutes intervals of non-face to face clinical time spent on patients using G2058.