Providers are increasingly using chronic care management (CCM) codes to address care fragmentation issues for patients with multiple chronic conditions. However, utilization patterns among providers could indicate some unaddressed challenges, according to a new study.
The study recently published in the American Academy of Family Physicians examined publicly available Medicare data from 2015 to 2018. The data captured all CCM claims submitted to Medicare by physicians during the four-year period.
Both service counts and corresponding Medicare payments for CCM rose between 2015 and 2018, the study found.
However, Medicare’s work promoting the use of CCM for more coordinated care is not over.
But the original CCM (CPT 99490) accounted for 93 percent of all CCM services, while complex CCM care management services (CPT 99487, CPT 99489, and G0506) represented just 7.9 percent of CCM services in 2017 and 10.6 percent in 2018.
Additionally, the study found that primary care physicians largely drove the increase in CCM code use over the four-year period.
Primary care physicians represented 78 percent of CCM use from 2015 to 2018, and the providers increased their use of the codes from 810,289 services in 2015 to 3,401,546 in 2018, representing $33,718,816 and $151,897,061 in payments, respectively.
In comparison, CCM use increased among medical specialists from 60,511 services in 2015 to 448,821 in 2018.
Recent research has also shown that CCM use disparities by practice size, with small physician practice use CCM codes far less frequently than their larger counterparts.
Finally, the study showed that Medicare denied about 4.8 percent of submitted CCM services from 2015 to 2018, with the denial rate being fairly consistently throughout the period.
Overall increases in CCM use, especially by primary care physicians, is a positive trend, the authors of the study said.
“This trend is encouraging given that fragmented care adds an estimated $75 billion in health care costs annually,” wrote lead author Ashok Reddy and colleagues from the University of Washington School of Medicine. “Our results lend support to Medicare’s decision to continue emphasizing CCM as part of payment reform in an effort to improve care improvements and reduce cost.”
However, Medicare’s work promoting the use of CCM for more coordinated care is not over.
First, newer CCM codes represented a minority of services provided, raising questions about the availability of CCM reimbursement, Reddy et al. stated.
CPT codes 99487 and 99489 provider higher reimbursement for complex care management compared to the original CCM code, CPT 99490, which reimburses clinicals for up to 20 minutes of non-face-to-care care management activities.
The add-on code G0507, which was introduced in 2017, also provides additional reimbursement for clinicians performing care planning activities after initiating chronic care management services.
Does CCM reimbursement incent clinicians to implement new care coordination activities or are clinicians using CCM to capture activities they have already implemented and use for patients with multiple chronic conditions, the authors asked.
Second, the CCM claim denial rate suggests administrative burdens attached to the use of the codes.
“Although low, the observation that 5% of claims are denied may suggest that the administrative burden for billing these codes discourage many clinicians from submitting claims at all, even if some of all CCM services are actually being delivered,” wrote Reddy et al.
This could spell trouble for the introduction of new CCM codes in the future since it is still unclear whether the reimbursement attached to CCM is enough to support a clinician’s investment in developing the staff, resources, and workflows needed for care coordination.
“These factors could limit use of newer complex CCM codes as well as forthcoming codes targeted at patients with a single chronic disease,” the authors wrote.
Whether CCM use leads to new developments for chronic disease management or just reimbursement for activities clinicians are already performing should be evaluated to make CCM code implementation and payment more effective, the study concluded.
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