VIRTUAL CARE PROGRAMS

VIRTUAL CARE SERVICES

CHRONIC CARE MANAGEMENT (CCM) is the care coordination that is outside of the regular office visit for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. It can be delivered to people with many different types of health conditions. CPT: 99490, 99439

REMOTE PHYSIOLOGICAL (or Patient) MONITORING involves the use of non-face-to-face technology to monitor and analyze physiological metrics of patients’ health such as blood pressure, oxygen saturation, blood oxygen levels, weight gain/loss, etc. CPT: 99454, 99457, 99458

REMOTE THERAPEUTIC MONITORING (RTM) Tracks a patient’s adherence to a therapeutic plan of care. According to the 2023 CMS Final Rule, RTM technology can be used to measure respiratory system status, musculoskeletal system status, therapy adherence, and therapy response. CPT: 98976, 98980, 98981

BEHAVIORAL HEALTH INTEGRATIONS (BHI) CMS supports behavioral health practices to provide integrated care and help meet people's behavioral needs, such as social isolation, depressions and cognition housing, all of which can negatively impact a person's ability to manage their care. CPT: 99484

ANNUAL WELLNESS VISIT (AWV) allows a practice to gain information about the patient, including medical and family history, health risks, and specific vitals. Not to be confused with a complete physical examination, the purpose of the AWV is to review the patient's wellness and develop a personalized prevention plan. For AWV, we do work before or during visit to support doctor such as cognitive screening, depression screening etc. It is exactly what an MA or nurse does in a clinic. The doctor interprets and sets the plan. We support the doctor for the health risk assessment (HRA). CPT: G0439

TRANSITIONAL CARE MANAGEMENT (TCM): Medicare may cover transitional care services during the 30-day period that begins when a physician discharges a Medicare patient from an inpatient stay and continues for the next 29 days. These services help eligible patients transition back to a community setting after a stay at certain facility types. CPT: 99495, 99496

SOCIAL DETERMINANTS OF HEALTH (SDoH): CMS strives to improve the collection and use of comprehensive, interoperable, standardized individual-level demographic and social determinants of health (SDoH) data, health literacy, including race, ethnicity, language, gender identity, sex, sexual orientation, disability status, and SDOH. CPT: G0136

CAREGIVER TRAINING SERVICES (CTS) covers caregiver training services for caregivers involved in the treatment of Medicare patients if both conditions apply:

The training focuses on helping the patient meet the health and treatment goals they set with their doctor or other health care provider.
The patient needs a caregiver’s help for their treatment to succeed.

If the patient’s healthcare provider determines that caregiver training is appropriate for the patient’s treatment plan, the caregiver can get individual or group training sessions from the provider without the patient present. CPT: 99550

COMMUNITY HEALTH INTEGRATION (CHI) & PRINCIPAL ILLNESS NAVIGATION (PIN) services involve a person-centered assessment to better understand the patient’s life story, care coordination, contextualizing health education, building patient self-advocacy skills, health system navigation, facilitating behavioral change, providing social and emotional support, and facilitating access to community-based social services to address unmet social determinations of health (SDoH) needs. CPT: G0019, G0023