How to bill for the CPT 99490 code – Chronic care management

How to bill for the CPT 99490 code – Chronic care management

The CPT 99490 code for Chronic Care Management is a relatively new code, introduced in January 2016. The code covers non-face-to-face services provided to qualifying patients: those with two or more chronic conditions such as hypertension or diabetes. CPT code 99490 reimbursement code addresses the rising number of routine visits, as well as the escalating healthcare costs, by incentifying doctors to reduce in-office appointments of frequent patients such as those with chronic conditions and replace them with virtual care in attempt to improve the quality of primary care and reduce healthcare costs. This CPT code 99490 pays $43 per each patient per calendar month who received a minimum of 20 minutes of care from clinical staff directed by a qualified healthcare professional. The 99490 code can be billed monthly on an ongoing basis given all criteria is met each month

What are the requirements for billing CPT 99490 code?
To be able to bill for the CPT 99490 code, a few simple requirements need to be met, including patient and practitioner eligibility, patient consent and minimum monthly care time. But with the right implementation, claiming reimbursement for each eligible patient is as simple as billing for other codes. Plus, 99490 code can be billed on a recurring basis, giving doctors a long lasting revenue stream as an alternative care model for their patients.

Who can bill for CPT 99490 code and who can perform CCM care?
CCM can be billed by primary care practitioners and many specialty practitioners such as cardiologists, neurologists, nephrologists and diabetes and hypertension specialists to name a few. Time spent directly by the chronic care staffing team will count towards the time required each month to bill for the CCM services. Non-clinical staff time cannot be counted but non-physician practitioners including certified nurses, nurse practitioners and physician assistants are all eligible to provide care and bill for this CCM code. If the patient is cared for by multiple care providers, only one practitioner can bill CPT 99490 for such patient.

Which patients qualify for care under CPT 99490 code?
All patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient are eligible for CCM services. A few examples of chronic conditions include Alzheimer disease, arthritis, asthma, atrial fibrillation, autism, cancer, cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes, hypertension, HIV and more. Care providers require the patient’s consent and are to complete an initiating visit with all new patients as well as those who haven’t been seen in more than a year. This initiating in-person visit is not part of CCM and is billed separately.

What are practitioner’s requirements to bill for 99490 code?
Many qualifying care providers can bill for 99490 code. These include medical license doctors (both primary care and some specialists), certified nurses, nurse specialists, nurse practitioners and physician assistants. Practices billing for this code need to ensure access to care and care continuity, implementation of a system to document such care and to track the time to meet the minimum of 20 minutes for 99490 CPT code. Practices will also need a certified EHR solution and create a comprehensive care plan for each billable patient.

What tasks are billable towards CPT 99490 code?
The CMS includes a long list of Chronic Care Management tasks that qualify towards the 99490 code and many of them were commonly practiced even before non-face-to-face care became reimbursable. These include communicating with the patient outside their appointment, usually done via video calls, phone, email or text messaging. It also includes creation of a care plan, analysis of patient’s vital received electronically, management of care transition between and amongst care providers, follow-up after a discharge, reviewing test labs and many more.

Are there other codes like CPT 99490 that can be used for CCM reimbursement?
Along with CPT code 99490, the CMS introduced two other codes for complex CCM service: CPT codes 99487, 99489. CPT code 99487 requires a minimum of 60 minutes of moderate or high complexity medical decision making in the given month and CPT code 99489 pays for each additional 30 minutes of such complex CCM service. CPT codes 99487 and 99489 cannot be billed concurrently with 99490 code meaning when a complex CCM was performed, such as establishment or substantial revision of the patient’s care plan, codes 99487 alone or together with code 99489, will be billed but not 99490 code.


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