CMS Rule Changes 2025

WIXOM, MICHIGAN / ACCESSWIRE / December 31, 2024 / The Centers for Medicare & Medicaid Services (CMS) has announced significant changes in the 2025, with a focus on remote care and care coordination services. These changes are intended to enhance transparency, streamline billing processes, and promote value-based care models for physicians, hospitals, Rural Health Centers (RHCs), and Federally Qualified Health Centers (FQHCs).

Elimination of the G0511

Effective January 1, 2025. RHCs and FQHCs will no longer be able to report this single code. Instead, they will need to use individual CPT and HCPCS codes that reflect the specific care coordination services provided. For example, CPT codes 99490 for non-complex Chronic Care Management and 99439 for additional time spent on Chronic Care Management will be used. This change aims to increase transparency and better align reimbursement with the services delivered. Additionally, CMS proposes adding new codes for extended care coordination, ensuring appropriate reimbursement for the service time.

To assist RHCs and FQHCs with the transition, CMS has allowed a six-month period, running until at least July 1, 2025, to update billing systems. This grace period will help these centers adapt to the new billing requirements.

Introduction of Advanced Primary Care Management (APCM)

APCM designed to support primary care physicians in transitioning to value-based care. APCM bundles care management services, incorporating elements of Chronic Care Management, Transitional Care Management, and Principal Care Management. CMS has introduced three new HCPCS G-codes to represent these services, stratified into three levels based on a patient’s number of chronic conditions. These codes are:

• Level 1 (G0556) for individuals with one chronic condition,

• Level 2 (G0557) for individuals with two or more chronic conditions,

• Level 3 (G0558) for individuals with two or more chronic conditions and status as a Qualified Medicare Beneficiary.

RHCs and FQHCs can participate in APCM services and receive payments based on national non-facility PFS amounts, thus increasing their reimbursement for these services. This inclusion is expected to improve care coordination and enhance the financial stability of these centers.

Additionally, CMS will include CPT codes for Chronic Care Management (CCM), Transitional Care Management (TCM), and Principal Care Management (PCM) as part of the APCM bundle. Unlike existing codes, the new APCM codes will not be tied to specific time thresholds, reducing administrative burdens for providers.

Finally, CMS proposes expanding telehealth services starting January 1, 2025. Under this proposal, physicians can provide real-time, two-way audio-only communication for telehealth visits when the patient is unable or unwilling to use video technology.

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Contact Information

Venkataraman Soundararajan
President, Humhealth
marketing@humworld.com
7346660002

SOURCE: HUMHEALTH

View the original press release on accesswire.com