CPT code 99490 is used for chronic care management (CCM) services, providing reimbursement for non-face-to-face care for patients with multiple chronic conditions. Here’s what you should know:
- Eligibility: Patients must have at least two chronic conditions that are expected to last 12 months or longer, or that place them at significant risk of death, acute exacerbation or decompensation, or functional decline.
- Services Covered: The code includes at least 20 minutes of clinical staff (e.g. Medical Assistant) time non-face-to-face care, including health monitoring, medication management, and care coordination directed by a physician or other qualified health care professional, per calendar month via phone communication.
- Billing Frequency: CPT 99490 can be billed monthly, as long as at least 20 minutes of care is provided during that month.
- Documentation: Accurate documentation is essential, including a care plan, patient consent, and time spent on care.
- Discussion during a phone check-in with the patient and caregiver:
- Monitor ADLs: Dressing, eating, personal hygiene, medication management, and daily routines.
- Monitor for symptoms: Agitation, confusion, and depression.
- Assess Caregiver Well-being: Physical and emotional health.
- Offer Resources: Caregiver support groups, respite care.
- Provide Training: Assistance with medications, daily tasks, and managing Alzheimer’s behaviors.
- Review Care Plan: Monthly check-ins to assess cognitive/physical status, medication adherence, and caregiver needs.
- Discussion during a phone check-in with the patient and caregiver:
Once a cognitive impairment care plan (CPT 99483) or diagnosis is established for conditions like Alzheimer’s disease and related dementia, CPT 99490 can be used for ongoing monthly management, particularly when a patient also has another chronic condition.
Reimbursement & Billing Guidelines:
- The National Medicare approved amount for CPT 99490 is $60.49 (check rates for your locality).
- Physicians, certified nurse midwives (CNMs), nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) are eligible to bill for CCM services once clinical staff (such as a medical assistant) documents a minimum of 20 minutes of phone communication, directed by a physician or another qualified healthcare professional, each calendar month.
- NOTE: Primary care practitioners most often bill CCM services, but some specialty practitioners may also provide and bill them.
Cost-Effective Care: While there may be patient cost sharing for CCM services, supplemental insurance like Medigap can help cover these costs. Additionally, managing chronic conditions proactively through CCM can help avoid the need for more expensive emergency care in the future.
By using CPT 99490, healthcare providers not only improve patient outcomes but also receive compensation for the ongoing care necessary to manage chronic conditions.
Resources:
MLN909188 – Chronic Care Management Services
