The ongoing evolution of telehealth over the past decade has rapidly enhanced virtual care management to improve patient outcomes and increase access to care. This article traces the evolution of virtual care management and reimbursement models. We begin with transitional care management in 2013 and end with chronic pain telemanagement in 2023.
Explore these milestones in reimbursement, from care management’s emergence in transitional and chronic care coordination to its expanding role in enabling remote monitoring, behavioral health integration, and principal care management.
2013 – The Evolution of Telehealth and Virtual Care Management
In 2013, the Centers for Medicare & Medicaid Services (CMS) enabled the evolution of telehealth and virtual care management by introducing new transitional care management (TCM) codes. This was to contain costs and reduce 30-day re-hospitalization with reimbursement for care management and care coordination services. TCM codes 99495 and 99496 became effective on January 1, 2013.
The TCM codes allowed clinicians to bill for time spent coordinating care 30 days after a patient was discharged from a hospital or skilled nursing facility. Most importantly, physicians could leverage technology to enhance patient care coordination and continuity between acute care and outpatient settings. In addition, it paved the way for more clinician involvement with less risk of medical error and readmission. Physicians were required to contact the patient within two business days after discharge.
2015 – The Evolution of Chronic Virtual Care Management Takes Hold
In 2015, the evolution of telehealth in virtual healthcare management evolved to address the needs of patients with long-term, chronic conditions. On January 1, 2015, Medicare introduced new chronic care management (CCM) codes. This meant clinicians could bill for non-face-to-face care coordination services for patients with multiple chronic conditions.
CMS outlined that CCM patients included those with two or more chronic conditions expected to last at least 12 months or until the death of the patient. The conditions must place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These frameworks and reimbursement structures encouraged healthcare providers to adopt virtual care solutions to improve outcomes for these complex patients.
2016 – The Evolution of Telebehavioral Health Through Collaborative Care
In 2016, CMS introduced the psychiatric collaborative care model. This allowed many more patients to access psychiatric expertise through virtual interdisciplinary telehealth collaboration. What sets the collaborative care model apart in integrating behavioral health services is its solid evidence base of positive outcomes, adherence to CCM principles, and focus on accountability and quality improvement.
Additionally, psychiatrists could be reimbursed for virtually consulting with primary care physicians and care managers to improve outcomes for patients with behavioral health conditions. Various mental health advocacy groups and organizations supported the integration in 2016. Specifically, the Psychiatric Substance Abuse and Mental Health Services Administration (SAMHSA) promoted collaborative care for its importance in addressing mental health within the broader context of the evolution of telehealth.
2018 – Virtual Behavioral Health Integration Evolves
Following the collaborative care model, more clinicians began virtually integrating behavioral health integration (BHI) services into primary care. In 2018, Medicare started to make payments for behavioral health integration services under CPT codes 99492, 99493, and 99494. Medicare allowed payment to physicians and non-physician practitioners for BHI services supplied to patients during a calendar month.
The integration and evolution of telebehavioral health received support and guidelines from CMS and SAMHSA. Evidence supports that incorporating behavioral health services into primary care is a key approach to enhancing outcomes for the millions of Americans living with mental or behavioral health issues. Qualifying patients were those with mental, behavioral health, or psychiatric conditions treated by the billing practitioner. It included substance use disorders that warranted BHI services. The diagnoses could be either pre-existing or made by the billing clinician.
2019 – Remote Patient Monitoring Codes Added
In 2019, CMS launched the new remote physiological monitoring (RPM) program and CPT codes that allowed physicians to be reimbursed for time spent monitoring patient key physiological metrics outside clinic settings between visits. RPM opened the door for more advanced virtual telehealth management of chronic and acute care conditions through digitally collected health data and analytics. Moreover, RPM aligns with CMS initiatives promoting value-based care and patient engagement in the evolution of telemedicine.
A 2023 study showed evidence of an uptake in RPM from 2019-2021. After examining Medicare Part B National Summary Data data files from January 2019 to December 2021, researchers found that new patients increased from 20,640 in 2019 to 90,149 in 2020 and 123,476 in 2021.
2020 – Principal Care Management Launches
Principal care management (PCM) codes debuted in 2020. The emphasis on strengthening primary care aligned with CMS’s commitment to promoting patient-centered telehealth care and improving overall healthcare quality. PCM covers disease-specific services in virtual care management for a single, complex chronic condition that puts a patient at risk of hospitalization, physical or cognitive decline, or death.
Qualifying patients must have one chronic high-risk condition expected to last at least three months. In addition, a patient must not be treated for other complex conditions. PCM enables more holistic virtual healthcare and telehealth management encompassing the breadth of a patient’s conditions and services.
2022 – Remote Therapeutic Monitoring Evolves
The paradigm shift in 2022 towards remote therapeutic monitoring was influenced by CMS guidelines and policies encouraging the use of technology to optimize therapeutic telehealth outcomes. Remote therapeutic monitoring (RTM) codes were released, allowing billing for the virtual delivery of physical, occupational, and speech therapies. RTM allowed patients to access more convenient treatments from home, supported by virtual monitoring and engagement in the evolution of telehealth.
Virtual healthcare and telehealth management evolved to provide continuous assessment and personalized interventions, aligning with CMS’s commitment to advancing patient care.
2023 – Chronic Pain Virtual Care Management Emerges
In 2023, chronic pain management CPT codes G3002 and G3003 were introduced to improve access to virtual pain care coordination and telemanagement. CMS developed virtual healthcare and telehealth management strategies for chronic pain to improve care experiences for individuals with chronic pain. In addition, the codes consider the time and resources furnished by clinicians.
2024 and Beyond – The Expanding Future of Telehealth and Virtual Care Management
In 2024, CMS added Principal Illness Navigation (PIN) incident-to-services to the 2024 Physician Fee Schedule Final Rule by the Centers for Medicare & Medicaid Services (CMS). The 4 new service codes are used for the services of a physician or billing practitioner under general supervision. There are 2 codes for PIN services and 2 codes for Principal Illness Navigation-Peer Support (PIN-PS) services. The aim of PIN services is to deliver a person-centered approach that prioritizes unique individual needs and goals. Additionally, a key goal of PINS is to empower patients and caregivers to navigate the intricate healthcare landscape effectively for timely access to appropriate care and resources.
The decade from 2013-2023 saw tremendous evolution in telehealth. Virtual care management advances enabled post-discharge contact to chronic disease management, behavioral healthcare integration to RPM, principal care coordination, and treatment via telehealth. Virtual connectivity continues enhancing healthcare management for providers and patients alike through the ongoing evolution of telehealth.
As technology and policy enable more advanced and integrated forms of telehealth, possibilities increase for enhancing access, outcomes, patient experience, and clinician collaboration. As virtual care management evolved from transitional care in 2013 to chronic pain telemanagement in 2023, CMS played a crucial role in shaping the evolution of telehealth.
Understanding the Evolution of Telehealth
Tenovi provides chronic care, telehealth, and remote patient monitoring software and services companies with hardware and software solutions for real-time access to their patient’s health and billing data. Contact Tenovi today for a free demo and consultation.
