Chronic Care Management

Friday, December 12, 2014 07:52 AM

Beginning Jan. 1, 2015 Medicare will pay for Chronic Care Management (CCM) services, CPT® code 99490 under Part B fee for service. The CPT® definition is:

“Services are provided when medical and/or psychosocial needs of the patient require establishing, implementing, revising, or monitoring the care plan. Patients who receive chronic care management services have two or more chronic conditions or episodic health conditions that are expected to last at least 12 months , or until the death of the patient, and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.”

Per CPT® 99490 billing requirements include:

• At least 20 minutes of clinical staff time directed by a physician spent in chronic care management services;
• Can only be billed once per month/per patient, AND by only one physician;
• Comprehensive care plan is established, implemented, revised or monitored.

Additional Medicare billing requirements were identified in Table 33 of the 2015 final physician fee schedule rule and include:

• Use of an EHR
• Beneficiary notification and consent - identify CCM services and obtain written agreement to have the services provided, including authorization for the electronic communication of his/her medical information with other treating providers (NOTE: Medicare pays for the service at 80 percent and the patient is liable for the 20 percent co-insurance.)
• Providing patient a written or electronic copy of the care plan

To view the complete table, click here.