Medicare's Care Management Codes Might Not Support Primary Care As Expected

Area of Science:

• Health Services Research
• Healthcare Policy
• Primary Care Medicine

Background:

• Centers for Medicare and Medicaid Services introduced new billing codes for transitional care management (TCM) and chronic care management (CCM) services.
• These codes aim to improve compensation for primary care activities beyond face-to-face visits.
• Observed low adoption rates of these novel billing codes necessitate further investigation.

Purpose of the Study:

• To analyze the patterns of adoption for TCM and CCM billing codes.
• To compare characteristics of practices that adopted TCM/CCM codes versus those that did not.
• To determine the extent to which non-primary care practices billed for TCM and CCM services.

Main Methods:

• Comparative analysis of practice characteristics based on TCM/CCM billing data.
• Examination of billing claims to identify the originating practice.
• Statistical comparison between adopting and non-adopting practices.

Main Results:

• Larger practices demonstrated higher likelihood of adopting TCM or CCM billing codes.
• Practices already utilizing other novel billing codes were more prone to adopt TCM/CCM.
• Over 20% of TCM claims and nearly 25% of CCM claims were billed by practices other than the beneficiary's usual primary care provider.

Conclusions:

• The adoption of TCM and CCM codes is associated with practice size and use of other novel codes.
• A significant proportion of TCM and CCM services were billed by non-primary care practices.
• Findings raise concerns regarding the effective support of primary care by these new reimbursement mechanisms.