Upcoming Changes in DME Billing for Chronic Disease Management
                     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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-in-dme-billing-for-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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UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT
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 ManagementH T(TTPSC://MWW)W.247MEDICALBILLINGSERVICES.COM/   
UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT
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 benHTeTfiPSt:s//W tWoW .h24e7MaElDtIhCAcLaBIrLeLI NfGaScERilViItCiEeSs.C OsMin/ ce 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
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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M     
UPCOMING CHANGES IN DME BILLING FOR CHRONIC DISEASE MANAGEMENT
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