As of January 1, 2015, Medicare will pay CPT code 99490, non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions, approximately $43 separately under the Medicare Physician Fee Schedule.
The requirements for CPT code 99490 chronic care management services (CCM) are:
- At least 20 minutes of clinical staff time
- Directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
- Comprehensive care plan established, implemented, revised, or monitored.
Examples of chronic conditions include, but are not limited to, the following:
- Alzheimer’s disease and related dementia;
- Arthritis (osteoarthritis and rheumatoid);
- Asthma;
- Atrial fibrillation;
- Autism spectrum disorders;
- Cancer;
- Chronic Obstructive Pulmonary Disease;
- Depression;
- Diabetes;
- Heart failure;
- Hypertension;
- Ischemic heart disease; and
- Osteoporosis.
Physicians and the following non-physician practitioners may bill the new CCM service:
- Certified Nurse Midwives;
- Clinical Nurse Specialists;
- Nurse Practitioners; and
- Physician Assistants.
The Centers for Medicare & Medicaid Services (CMS) provided an exception under Medicare’s “incident to” rules that permits clinical staff to provide the CCM service incident to the services of the billing physician (or other appropriate practitioner) under the general supervision (rather than direct supervision) of a physician (or other appropriate practitioner). CMS requires the billing practitioner to furnish an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), or comprehensive evaluation and management visit to the patient prior to billing the CCM service, and to initiate the CCM service as part of this exam/visit.
Medicare requires the patient to be informed prior to billing of service. Only one provider can bill monthly for the service. Care management must be documented in the medical records. Requirements on the informed consent given to the beneficiary and documentation requirements can be found here.