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Your Guide to Maximizing Your CPT 99490 Reimbursement — 2022 Edition

Chronic Care management (CCM) services help Medicare patients with chronic conditions improve and manage their health. Medicare and Medicaid reimburse providers who provide CCM programs, which in turn reduce patient costs and healthcare spending. A wide variety of health care providers are eligible to provide CCM services and bill CCM codes. 

What Is CCM Billing?

Before even thinking about billing for CPT 99490, providers should know the basics of what Chronic Care Management (CCM) is all about. The ongoing shift to value-based care has shown the need for more preventative programs that focus on addressing patients’ health conditions before they worsen. The intention of these programs is to improve patient outcomes, reduce healthcare spending, and reduce hospital readmission rates - all goals that are not only beneficial for the patient, but also for the healthcare system as a whole. Enter: Chronic Care Management, a program that focuses on managing Medicare patients who have multiple chronic conditions.

What Is CCM Billing? 

Before billing for CPT 99490, providers should know what Chronic Care Management (CCM) is all about. CCM services are typically non-face-to-face services focused on assisting Medicare patients with two or more chronic conditions that are expected to last at least a year. The increase in the focus on value-based care has shown the need for more preventative programs that address patients' health conditions before they worsen. CCM services are critical to primary care because they benefit patients and healthcare systems by:

  • Improving patient outcomes.
  • Reducing healthcare spending.
  • Decreasing hospital readmission rates.

In 2015, the Centers for Medicare and Medicaid Services (CMS) began reimbursing providers who offered CCM for their patients on a per month, per enrolled patient basis. Since then, the program has been proven to reduce hospitalizations by nearly 5%, reduce emergency department visits by 2.3% and increase preventative care E&M encounters by 8%. 

CCM Patient Qualifications

Although preventive care benefits everyone, the Chronic Care Management program focuses on Medicare beneficiaries with two or more documented chronic conditions in their health records. CMS defines chronic conditions as those that increase a patient's risk of death, functional decline or acute exacerbation/decompensation and last for at least one year or the remainder of their life.

There is a long list of conditions that qualify, but some of the most common include diabetes, hypertension, depression and hyperlipidemia. Patients can only be enrolled in Chronic Care Management under one provider, and they must have visited the provider within the past year to qualify for the program. 

All patients must provide their consent to be enrolled in the program and are unable to unenroll at any time. At this time, most patients will require a small monthly copay to remain in the program.  

Who Can Bill CCM Codes?

A wide variety of qualified health care professionals can provide Chronic Care Management services. Physicians and non-physician providers are eligible to bill CCM codes:

  • Physician Assistants 
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Nurse-Midwives

While clinicians, health coaches, and more can perform general CCM functions, all medical decision-making is left up to the provider. Most frequently, primary care providers are the ones who offer CCM, but several specialties are also qualified to offer CCM, such as nephrology, urology and cardiology. Limited license practitioners and physicians such as dentists and psychologists cannot bill for CCM, but primary practitioners can consult with them to manage and coordinate care. 

What Are the Service Requirements for CCM?

In order to successfully bill for CCM services, providers must document a minimum of twenty minutes of clinical staff time per patient spent on care coordination. Care coordination activities include a wide variety of non-face-to-face care, including refilling prescriptions, coordinating transportation and appointments, follow-up, creation of care goals, and documentation of a care plan. A comprehensive care plan is one of the core requirements of CCM that must be documented in the electronic health record (EHR). The plan can then be shared with the patients’ other current healthcare providers as well as any caregivers so that the patients’ healthcare network stays connected. CCM services are billable once per calendar month that the patient is enrolled. 

What are the billing requirements of CCM? 

The 99490 CPT code can be billed for the initial twenty minutes of non-face-to-face care provided and documented for the patient each calendar month. Reimbursement for this service can vary by state and practice type. For example, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) are typically reimbursed at a higher rate than a standard practice. 

FQHC and RHC Billing Requirements

Prior to billing for CCM monthly services (99490 or G0511) for the first time, you may elect to bill G0506, face-to-face CCM Consent, for patients as they come in to see their provider.  Those who provide continued care planning after the 20 minutes of billable time required for CPT 99490 within a month may be eligible to bill for Complex Chronic Care Management, which has additional

Before billing for CCM monthly services (CPT 99490 or G0511) for the first time, you may elect to bill G0506, an add-on code used exclusively for initiating visits. Providers may only bill this code once, and they must list it separately as an addition to the primary service.

Those who provide continued care planning after the 20 minutes of billable time required for CPT 99490 within a month may be eligible to bill for Complex Chronic Care Management, which has additional requirements for clinical staff time and a higher level of medical decision-making.

Trust ChartSpan for All Your CCM Needs

ChartSpan offers the nation's most successful CCM program. With ChartSpan, you can provide your patients with 24/7 access to care management services. Our care team will act as an extension of your care services and reach out to enrolled patients for you monthly. Our full-service solution covers a wide range of important services so you can focus on caring for patients. 

The ChartSpan team can also help you simplify a previously tedious billing process. ChartSpan's RapidBillAuto technology optimizes billing so you can bill faster and easier, saving time for your billing team.

Our CCM solution improves patient outcomes and works towards better quality scores so you can increase revenue and help Medicare patients remain loyal to your practice. We help patients adhere to care plans and reach goals by providing 24/7 support and coordinating their care between you and their other providers. If you have any questions about Chronic Care Management and the billing requirements, reach out to us and we will be happy to help.

Contact ChartSpan for Optimized CCM Solutions

CCM services reduce healthcare costs and improve patient health. With ChartSpan CCM solutions, you can provide your patients with a fantastic experience while saving time and money. Contact us to learn more about Chronic Care Management and its billing requirements.

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