Success Questionable for New CMS Billing Codes

Person bookkeeping on laptop and using calculator Image by William Iven from Pixabay

The Centers for Medicare and Medicaid Services (CMS) has introduced new billing codes for transitional care management and chronic care management to enhance payments for the provision of primary care services that do not takes place in-person.

Non-visit-based services such as coordination, messaging, and managing population health were previously not recognized in the Medicare Physician Fee Schedule. In Health Affairs, PhD candidate in health policy at Harvard University Sumit D. Agarwal, MD, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health Michael Barnett, PhD, department of health care policy biostatistician, Jeffrey Souza, and professor of health care policy Bruce E. Landon, MD, MBA investigated the adoption and use of these new billing codes.

The study found that the adoption of both the transitional care management billing code and chronic care management billing code were low. Larger practices and those that utilized other novel billing codes were more likely to adopt the use of these new codes. Importantly, over a fifth of all transitional care management claims and almost a quarter of chronic care management claims were billed by a practice that was not the beneficiary’s assigned primary care practice, suggesting that the new codes may not be always functioning as designed.  The authors speculate that the complexity of mastering the nuances of billing for these and other newly released codes is likely a major reason for the slow uptake.

While the adoption of these new billing codes has proved successful in some practices, these findings question whether these codes are supporting primary care as they were designed to do.