WASHINGTON -- Physicians will have new codes to use to get paid for chronic care management under a final rule issued Wednesday by the Centers for Medicare & Medicaid Services (CMS).
"These policies will give significant support to the practice of primary care and boost the time a physician can spend with his or her patients listening, advising, and coordinating their care," CMS Acting Administrator Andy Slavitt said in a press release.
Under the final rule, the agency will make separate payments for certain existing Current Procedural Terminology (CPT) codes describing non-face-to-face prolonged evaluation and management services. CMS also will revalue existing CPT codes describing prolonged face-to-face services.
The agency also said it will make separate payments under a new code for "comprehensive assessment and care planning for patients with cognitive impairment (e.g., dementia)," according to a CMS fact sheet. Some of the codes will encompass integrated healthcare for behavioral health patients that might include coordination between a behavioral health specialist, behavioral healthcare manager, and a primary care physician.
CMS also is expanding its Medicare Diabetes Prevention Program services to make them available to all beneficiaries. "We know that fewer people with diabetes saves patients and Medicare money because they use fewer expensive prescription drugs and have fewer hospital visits," the blog post said. "And most importantly, by preventing diabetes, patients and families across the country can avoid suffering from a debilitating disease."
In terms of how much money diabetes prevention could save, "we estimate that Medicare will spend $42 billion more in the single year of 2016 on fee-for-service, non-dual eligible, over age 65 beneficiaries with diabetes than it would spend if those beneficiaries did not have diabetes -- $20 billion more for Part A, $17 billion more for Part B, and $5 billion more for Part D," CMS noted in a separate diabetes program fact sheet.
The prevention program is a year-long weight-loss intervention that consists of at least 16 weekly core hour-long sessions followed by at least 6 monthly core maintenance sessions, furnished regardless of weight loss. In addition, beneficiaries have access to 3-month intervals of ongoing maintenance sessions after the core 12-month intervention if they achieve and maintain the required minimum weight loss of 5% in the preceding 3 months.
Other final regulations announced by CMS include:
- Releasing final values for the new CPT moderate sedation codes and adding an endoscopy-specific moderate sedation code
- Adding several codes to the list of services eligible to be furnished via telehealth, including end-stage renal disease-related services for dialysis, advance care planning, and critical care consultations
- Finalizing a new coding framework based on new CPT codes for mammography services intended to account for current technology used in mammography
"These coding and payment changes will better reflect the resources involved in furnishing comprehensive primary care, care coordination and planning, mental health care, and care for cognitive impairment, such as Alzheimer's disease," the agency said.