2023 CPT changes for Internal and Family Medicine

Remote therapeutic monitoring (98975-98978, 98980 and 98981).  

CPT has revised the description for remote therapeutic monitoring code 98975 to accommodate the addition of a new CPT code, 98978, specifically for monitoring for cognitive behavioral therapy. (The description’s parenthetical section now includes only “therapy adherence” and “therapy response.” References to respiratory and musculoskeletal systems have been removed.) As with remote monitoring codes 98976 and 98977, clinicians will use code 98978 once per 30-day monitoring period to report supplying the monitoring device to the patient for scheduled recordings and/or programmed alert transmissions. 

CPT has also revised the introductory guidelines to the remote therapeutic monitoring section to recognize the new code and made changes to the introductory guidelines for remote therapeutic monitoring treatment management services to clarify the appropriate reporting of these services. There are no changes to the existing CPT codes 98980 and 98981 for remote therapeutic monitoring treatment/interactive communication.

98975 – Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment

• Do not report 98975 more than once per episode of care
• Do not report 98975 for monitoring of less than 16 days

98976 – Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

98977 – Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days

• Do not report 98975, 98976, 98977 in conjunction with codes for more specific physiologic parameters [93296, 94760, 99453, 99454]
• Do not report 98976, 98977 for monitoring of less than 16 days
• For therapeutic monitoring treatment management services, use 98980
• For remote physiologic monitoring, see 99453, 99454

• For physiologic monitoring treatment management services, use 99457
• For self-measured blood pressure monitoring, see 99473, 99474

   

98978: Remote therapeutic monitoring (e.g., therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days (new code effective January 1, 2023)

98980: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

98981: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (listed separately in addition to code for primary procedure)

Vaccine product and administration codes

CPT 2023 includes multiple new codes for COVID-19 vaccines and their administration. CPT also revised several codes to accommodate changes in patient ages as vaccine guidelines were updated. The codes are unique for each of the COVID-19 vaccines approved in the U.S., and administration codes are unique to each vaccine and dose. All COVID-19 vaccine codes and administration codes are listed in the vaccine section of CPT and in Appendix Q.

Other new vaccine codes this year include the following:

• 90584, “Dengue vaccine, quadrivalent, live, 2 dose schedule, for subcutaneous use,”
• 90678, “Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use.”

CPT has also revised code 90739 to read, “Hepatitis B vaccine (HepB), CpG-adjuvanted, adult dosage, 2 dose or 4 dose schedule, for intramuscular use.” The American Medical Association maintains current information on all CPT vaccine codes on its website.

Suture or staple removal:

There are three new codes in the integumentary system section that could affect your practice, plus one deletion and one revision.

New mesh code:

• 15778 (Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma).

Two new suture codes:

• +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code))
• +15854 (Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code))

Suture changes to note:

• 15850 has been deleted (Removal of sutures under anesthesia (other than local), same surgeon)
• 15851 has been revised to state “Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation).”

Behavioral Health Services 

In light of the current needs among Medicare beneficiaries for improved access to behavioral health services, CMS has considered regulatory revisions that may help to reduce existing barriers and make greater use of the services of behavioral health professionals, such as licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs). Therefore, CMS is finalizing the proposal to add an exception to the direct supervision requirement under our “incident to” regulation at 42 CFR 410.26 to allow behavioral health services to be provided under the general supervision of a physician or non-physician practitioner (NPP), rather than under direct supervision, when these services or supplies are furnished by auxiliary personnel, such as LPCs and LMFTs, incident to the services of a physician (or NPP). CMS is also clarifying that any service furnished primarily for the diagnosis and treatment of a mental health or substance use disorder can be furnished by auxiliary personnel under the general supervision of a physician or NPP who is authorized to furnish and bill for services provided incident to their own professional services. CMS believes that this change will facilitate access and extend the reach of behavioral health services. Finally, CMS indicated in the final rule that we intend to address payment for new codes that describe caregiver behavioral management training in CY 2024 rulemaking.

In the 2022 CMS Behavioral Health Strategy (https://www.cms.gov/cms-behavioral-health-strategy), CMS included a goal to improve access to, and quality of, mental health care services and included an objective to “increase detection, effective management, and/or recovery of mental health conditions through coordination and integration between primary and specialty care providers.” In CY 2017 and 2018 PFS rulemaking, CMS received comments that initiating visit services for behavioral health integration (BHI) should include in-depth psychological evaluations delivered by a clinical psychologist (CP), and that CMS should consider allowing professionals who were not eligible to report the approved initiating visit codes to Medicare to serve as a primary hub for BHI services. Considering the increased needs for mental health services and feedback we have received; we are finalizing our proposal to create a new General BHI code describing a service personally performed by CPs or clinical social workers (CSWs) to account for monthly care integration where the mental health services furnished by a CP or CSW are serving as the focal point of care integration. CMS is also finalizing the proposal to allow a psychiatric diagnostic evaluation to serve as the initiating visit for the new general BHI service.

Multiple-family group behavior management/modification training

New codes 96202 and 96203 are for multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis.  

• 96202 Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes
• 96203 each additional 15 minutes

Additional new codes describe the respiratory syncytial vaccine (90678)

• 90678 Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use

Chronic Pain Management and Treatment Services 

CMS finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. We believe the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership.

The finalized codes include a bundle of services furnished during a month that we believe to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. We have finalized the CPM codes to include the following elements in the code descriptor: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate.

Therefore, CMS is implementing separate coding and payment for chronic pain management (CPM) services beginning Jan. 1, 2023. The agency will allow non-physician practitioners (e.g., nurse practitioners and physician assistants) to provide CPM and requires the initial visit to be face-to-face. CMS has created two HCPCS codes to report monthly CPM:

• G3002, “Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (When using G3002, 30 minutes must be met or exceeded.)”
• G3003, “Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month (list separately in addition to code for G3002). (When using G3003, 15 minutes must be met or exceeded.)”