Chronic care management services have been recognized by Medicare for some time now as being an important integral part to managing chronically ill patients. With payment models leaning towards transitioning into outcomes of patient care, and more Accountable Care Organizations forming, it is now more important to ever to make sure that you are capturing the work you are doing as a provider for these patients, as well as not leaving any money on the table for the work you are doing.

The minimum CPT code 99490 chronic care management services as defined by Medicare, in order to be reported, must encompass at least 20 minutes of documented patient care per calendar month, and may only be billed once per calendar month for patients with at least two chronic conditions. These conditions must put a patient at significant health risk, in an acute problematic status, or present a functional decline to the patient’s well-being. The provider must be able to show that a plan for care and monitoring has been well established, and monitored.

Examples of chronic conditions are asthma, hypertension, diabetes, cancer, atrial fibrillation, etc. just to name a few. More than likely, to capture the needed documentation requirements would not be that daunting as providers are probably providing the majority of requirements as it is, but just haven’t taken the time to look into capturing all of the data in a documented form.
Chronic Care Management CPT and requirements are as follows:

99490 CCM with at least 20 minutes of clinical staff time:

  • Must have 2 or more chronic conditions putting a patient at significant health risk
  • Requires care plan to be monitored with the patient

99487 CCM with at least 60 minutes of clinical staff time:

  • Multiple (2 or more) chronic conditions that are expected to last at least 12 months or until the patient passes away presenting significant health risk and/or are exacerbated
    Requires care plan monitoring with at least a moderate medical decision making utilized
  • 99489 Each additional 30 minutes per calendar month of clinical staff time

All CPT’s require the billing practitioner’s direct supervision, even though he or she may not be the actual clinical staff person performing the services such as patient phone contact. The billing practitioner remains responsible and must be able to ensure that the care plan is monitored and adjusted at their direction, and that they are in agreement with any clinical staff person’s evaluation.

Since this is a billable service, it is important to inform the patient that this is being billed, and there will be applicable coinsurances involved. It is recommended that staff educates and gets written approval and consent to be in this type of ‘program’ with the providers office.

 

About the Author:

Amanda Raveaux, CPC, CPB, CPPM, CFPC, CH-CBS is a Medical Billing and Coding Supervisor, and has been in the billing and coding arena for 17 years. She has received her training from The American Academy of Professional Coders, and holds multiple certifications, as well as achieving certification for Community Health billing.