In 2015, Medicare began paying for Chronic Care Management (CCM) under code 99490: chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. The services require:
- The patient to have two or more chronic conditions that are expected to last at least 12 months or until the death of the patient
- The conditions place the patient at significant risk or death or functional decline
- A comprehensive care plan needs to be established and monitored
For services to qualify under code 99490, among other elements, the patient needs to be able to get successive appointments, care management must include system based approaches, enhanced opportunities for a patient and any relevant caregiver to communicate with the provider regarding the beneficiary’s care must exist, and care plan information must be available on a 24/7 basis to all providers within the practice who are furnishing CCM services and whose time counts toward the time requirement for billing the CCM code.
While many physicians feel that the requirements outweigh the return, there are strategies such as hiring clerks to for necessary documentation, that can simplify the process and the benefits could be far reaching as, according to the Centers for Medicare and Medicaid Services, as many as two-thirds of Medicare beneficiaries have had two or more chronic conditions simultaneously. Here are some things to keep in mind:
CPT code 99490 cannot be billed during the same service period as CPT codes 99495–99496 (transitional care management), Healthcare Common Procedure Coding System (HCPCS) codes G0181/G0182 (home health care supervision/hospice care supervision), or CPT codes 90951–90970 (certain End-Stage Renal Disease services). There may be additional restrictions on billing for practitioners participating in a CMS sponsored model or demonstration program.
With 20/20 MD in your court, medical billing is skillfully handled for you. 2020 MD Billing is committed to substantially improve your billing processes, with immediate and measurable financial results. We ensure maximum reimbursement for the services rendered and we work with you and your patients with the utmost courtesy and respect. Call today to learn more about CPT 99490.