Chronic disease management significantly benefits from Durable Medical Equipment (DME) as it offers necessary medical devices that patients need to track and uphold their health.

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UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT

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UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT
Chronic disease management significantly benefits from Durable Medical Equipment (DME)
as it offers necessary medical devices that patients need to track and uphold their health. The
Centers for Medicare & Medicaid Services (CMS) started making substantial revisions to
DME billing procedures for 2025 as healthcare policies continue changing. These billing
system updates strive to unite healthcare providers to improve patient care, simplify payment
processing, and reward value-based care approaches. The modifications require complete
understanding from healthcare providers working with patients who manage chronic diseases.
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r-chronic-disease-management
Key Changes in DME Billing for 2025
1. Elimination of HCPCS Code G0511 for Care Coordination Services
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) applied HCPCS code G0511
throughout history to submit bills for their Chronic Care Management (CCM) services. The Centers for
Medicare and Medicaid Services (CMS) will discontinue its use of code G0511 starting January 1, 2025, as
they plan to introduce individual CPT and HCPCS codes for improved billing specificity. The transition
brings greater clarity about the services that lead to precise reimbursement payments.

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2. Transition to Individual CPT Codes
The removal of G0511 requires healthcare providers to use specific Clinical Procedure Terminology codes
for Chronic Care Management documentation and accurate reimbursement processes:
CPT Code 99490 – Non-complex Chronic Care Management services requiring at least 20 minutes of
clinical staff time per month.
CPT Code 99439 – Additional time spent on Chronic Care Management beyond the initial 20 minutes.
This change aligns payments with the complexity and duration of care coordination activities, ensuring fair
compensation for RHCs and FQHCs.
3. Introduction of Advanced Primary Care Management (APCM) Services
Under the 2025 Medicare Physician Fee Schedule (PFS) the Centers for Medicare & Medicaid Services
(CMS) introduces Advanced Primary Care Management (APCM) services. APCM organizes multiple
healthcare management services to support primary care physicians in their mission to provide organized
patient-centric care.This initiative integrates elements of:
Principal Care Management (PCM)
Transitional Care Management (TCM)
UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT

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The strategy proves to be beneficial for patient care by assisting primary care doctors in creating improved
treatment organizations for patients who have prolonged health concerns. Through APCM, CMS intends to
unite different care management systems while eliminating unnecessary office work so providers can provide
more attention to patient assessment.
To facilitate the implementation of APCM, CMS has introduced three new HCPCS G-codes:
G0556: For patients with a single chronic condition requiring ongoing management.
G0557: For patients with two or more chronic conditions requiring active care coordination.
G0558: For patients with multiple chronic conditions who are also Qualified Medicare Beneficiaries (QMBs),
meaning they are eligible for additional financial assistance.
Through these codes administrators no longer need to use time-based restrictions which decreases
administrative workloads. APCM payment systems adjust financial compensation based on patient health
requirements to allow for personalized long-term care administration.
4. Impact on RHCs and FQHCs
APCM services present an excellent opportunity for both RHCs and FQHCs to enhance their patient care
practices. The centers can engage in APCM services by using the national non-facility PFS payment rates
when they submit claims containing suitable APCM codes.
The coding shift delivers dual benefits to healthcare facilities since it both strengthens their financial status
and allows better coordination between services and improved patient oversight with better health outcomes.
An organized payment system enables RHCs and FQHCs to maximize resources for enhancing their premium
healthcare services to underserved communities.
UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT

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5. Six-Month Transition Period
The Centers for Medicare & Medicaid Services (CMS) provides a six-month transition period from January 1,
2025, up to at least July 1, 2025, to ease the implementation of this change. The six-month planning period
requires healthcare practitioners to modify their billing procedures and train their teams while incorporating
new CPT and HCPCS codes into their operational workflow.
The transition timeframe serves as the paramount factor in maintaining legal compliance and uninterrupted
insurance claim processing. The transitional period provides healthcare entities with a chance to review
billing procedures, identify errors, and enhance documentation systems.
6. Enhancements in Telehealth Services
Starting January 1, 2025, CMS proposes allowing real-time, two-way audio-only telehealth services when:
A distant-site physician has access to video technology.
The patient is unable or unwilling to use video conferencing.
Patients in rural locations or areas with limited technology experience now receive better medical care
through this system modification.CMS seeks to improve medical care delivery for patients with
chronic diseases through their expansion of telehealth services which combines reduced hospital visits
and better medical access.

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UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT
Conclusion
The upcoming DME billing changes for chronic disease management in 2025 signify a
transformative shift toward more personalized, coordinated, and value-based care.
Healthcare providers operating within RHCs and FQHCs need to implement these
modifications as they will help maximize reimbursements while delivering better patient care.
The updated knowledge and utilization of these modifications enable healthcare providers to
maintain simplified billing operations which results in better care outcomes for chronic
disease patients. Healthcare providers should consider using medical and billing services
provider company 24/7 Medical Billing Services as their outsourced partner to navigate
complex changes and meet billing regulations.

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About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing service provider
catering services to more than 42 specialties across the entire 50 states. You can rely
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Call us today at 888-502-0537 to know more on how we can help boost profitability
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Media Contact:
24/7 Medical Billing Services,
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3001 Greenfield Drive, Marietta GA, 30068
Texas:
2028 E Ben White Blvd, #240-1030 Austin TX, 78741
Tel: + 1 -888-502-0537
Email - info@247medicalbillingservices.com
UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT