What are the requirements of the CPT 99490?
CPT 99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician . or other qualified health care 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
How to Bill chronic care management 99490 to Medicare?
How to Bill Chronic Care Management 99490 to Medicare 1 Inform the patient of CCM availability, and obtain written authorization for services. 2 Explain the services as well as possible cost-sharing expenses. 3 Explain how to revoke services... 4 Inform the patient of CCM billing limitations...
How often can CCM CPT code 99439 be used?
CCM CPT Code: 99439 can be used every month. Instead of the required 20 minutes of care provided by a provider or QHP, it is 30 minutes of additional care. For patients to qualify, they must have two or more chronic conditions expected to last at least 12 months or until death.
What is the difference between CPT 99490 and g2058?
HCPCS code G2058 (announced for CY 2020, effective January 1, 2020) – while a provider bills CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM services in a calendar month, G2058 can be used for the second and third 20-minute increments.
How often can CPT code 99490 be billed?
every monthCCM CPT Code: 99490 is the most common billing code and can be used every month. There is a required 20 minutes of care provided by a provider or qualified healthcare professional (QHP).
How much does Medicare reimburse for CCM?
Chronic Care Management (CCM)CPT 99490 Initial 20 minutes, clinical staffCPT 99437 Subsequent 30 minutes, physician or NPPPrincipal Care Management (PCM)CPT 99426 (previously G2065) Initial 30 minutes, clinical staffCPT 99425 Subsequent 30 minutes, physician or NPP1 more row
Does Medicare cover CCM?
CCM is covered under Medicare Part B. This means that Medicare will pay 80 percent of the cost of service. You'll be responsible for a coinsurance payment of 20 percent.
What is procedure code 99490?
CPT code 99490 - non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability.
Can TCM and CCM be billed in the same month?
Previously, CCM time couldn't be billed in the same month for a patient that you are already billing TCM time for. This change now allows you to bill for both TCM and CCM in the same month for the same patient when “reasonable and necessary”.
Can 99490 and 99439 be billed together?
For example, if CCM services were provided for at least 40 minutes with a patient in a given month that was not Complex, 99490 ($42) and 99439 ($38) would be billed together for that month. Actual reimbursements may vary depending on the region.
How often can CCM be billed?
once per monthWhat is “calendar month” billing? A claim for CCM, using code 99490, may be submitted to Medicare once per month when the requirements of the service are met. Twenty minutes of clinical staff time must be spent in non-face-to-face care management of chronic conditions as outlined in the patient's care plan.
Can you bill for CCM during the same month of an annual wellness exam?
Can you bill for CCM during the same month of an annual wellness exam? Yes. CMS is requiring that a comprehensive visit, initial preventive physical exam (also known as the Welcome to Medicare visit), or annual wellness visit be performed prior to billing CCM.
What does a chronic disease management plan cover?
GP Management plan (GPMP) Then you should write a plan that describes: the patient's healthcare needs, health problems and relevant conditions. management goals and actions for your patient. treatment and services that your patient will need.
Does Medicare pay CPT 99490?
Chronic Care Management CPT 99490 As of January 1, 2015, Medicare began reimbursing for Chronic Care Management (CCM) services using CPT Code 99490. This service is for Medicare patients with multiple chronic conditions and is non-face-to-face.
How do I bill 99490 to Medicare?
Use 99490 for 20 minutes of service, regardless of the time over 20 minutes. The place of service should be listed as the provider's office, or location code 11. Bill under Medicare Part B. Use the “Date of Service” listed from the clinical record when billing manually.
Who can bill for CPT 99490?
Many qualifying care providers can bill for 99490 code. These include medical license doctors (both primary care and some specialists), certified nurses, nurse specialists, nurse practitioners and physician assistants.
What is CPT 99487?
The CCM codes (CPT 99487, 99489, and 99490) are assigned general supervision under the Medicare PFS. General supervision means when the service is not personally performed by the billing practitioner, it is performed under his or her overall direction and control although his or her physical presence is not required. Patient Eligibility Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline are eligible for CCM services.
How long is CCM 99490?
Chronic Care Management Services#N#– CCM#N#CPT 99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
What is a person centered care plan?
● A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment, and an inventory of resources (a comprehensive plan of care for all health issues, with particular focus on the chronic conditions being managed)
Can a billing practitioner report CCM?
The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex CCM during a given service period, not both.
What is the HCPCS code for CCM?
HCPCS code G2058 (announced for CY 2020, effective January 1, 2020) – while a provider bills CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM services in a calendar month, G2058 can be used for the second and third 20-minute increments.
Who can bill for CCM?
Several different types of practitioners may bill for CCM, including: Other clinical staff may provide the CCM service if they are working under the general supervision of an eligible practitioner. Federally Qualified Health Centers, Rural Health Clinics, and Critical Access Hospitals can also bill for CCM services.
What is the 99490 reimbursement?
Associations are another source of knowledge for 99490 reimbursement. Many times the association will have a provider education team that coaches providers on changes to healthcare policy, coding, etc. These teams also speak to a variety of practices; chances are one of these practices has launched a Chronic Care Management program and knows the rates for major insurance plans in your area. Often associations may have already launched a training module on CCM and have gathered all this information for you already!
What is 99490 billing?
Staying on top of local reimbursement policies is one of the core functions of any medical billing agency. Whether it’s your own biller or simply one that is in your area, billers deal with claims from across many practices and many payers. If even one of their clients participates in a Chronic Care Management program, chances are they have billed 99490 at some point. They should have information on the reimbursement rates from these claims. If not, they still deal with payers on a day to day basis to handle denials and other claim submission issues. They can reach out to their payer contacts to get to the bottom of what the 99490 rates are in your area.
1. What are the requirements of a CCM service?
CCM services require documentation of 20 minutes of non-face-to-face care per enrolled CCM patient, per calendar month in order to bill.
2. Which types of care providers can participate in Chronic Care Management?
Chronic Care Management services can be performed under general supervision, “incident to” referring to non-physician services or supplies furnished as an integral but incidental, part of a physician’s professional services. Primary care and a variety of specialities qualify to provide these CCM services.
3. Can CCM be billed on the same day as a provider office visit or hospital visit?
Yes, but you will need to use a 25 modifier. Another option is to move the CCM Date of Service (DOS) to the following day for office visits and following discharge for hospital stays. The alternate dates must lie within the billing month.
4. What Date of Service should be used in the claim?
The day 20 minutes of billable time is reached is the best DOS to use in your claim. However, you can use an alternate date as long as the 20 minutes of billable time has been completed on or before the last date of the month in that billing month.
6. Are there certain codes or services that can and cannot be billed in the same month as Chronic Care Management?
Qualified healthcare professionals cannot bill for CCM services during the same service period that care management is being provided by another facility or practitioner. In addition, the services listed below and their corresponding codes cannot be billed within the same month as CCM.
7. Is it required to speak to the patient every month in order to bill for Chronic Care Management?
No. While every attempt should be made to reach each enrolled patient every month, it is likely that some patients will choose not to engage in any given month. This does not mean that you cannot bill during a month that the patient cannot be reached.
8. Who collects the coinsurance?
The healthcare provider is responsible for collecting the 20% coinsurance for traditional Medicare plans. The cost will vary for Medicare Advantage plans. If CCM is outsourced to a partner, the billing provider is still responsible for collection.
When is CPT 99490 billed?
CPT 99490 can be billed if the beneficiary dies during the service period, as long as at least 20 minutes of qualifying services were furnished during that calendar month and all other billing requirements are met.
What is CPT 99490?
CPT 99490 describes activities that are not typically or ordinarily furnished face-to-face, such as telephone communication, review of medical records and test results, and consultation and exchange of health information with other providers. If these activities are occasionally provided by clinical staff face-to-face with the patient but would ordinarily be furnished non-face-to-face, the time may be counted towards the 20 minute minimum to bill CPT 99490. However, see #12 below regarding care coordination services furnished on the same day as an E/M visit.
What is provider based outpatient?
provider-based outpatient department of a hospital is part of the hospital and therefore may bill for CCM services furnished to eligible patients, provided that it meets all applicable requirements. A hospital-owned practice that is not provider-based to a hospital is not part of the hospital and, therefore, not eligible to bill for services under the OPPS; but the physician (or other qualifying practitioner) practicing in the hospital-owned practice may bill under the PFS for CCM services furnished to eligible patients, provided all PFS billing requirements are met.
How long does a CPT 99490 bill take?
The service period for CPT 99490 is one calendar month, and CMS expects the billing practitioner to continue furnishing services during a given month as applicable after the 20 minute time threshold to bill the service is met (see #3 above). However practitioners may bill the PFS at the conclusion of the service period or after completion of at least 20 minutes of qualifying services for the service period. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.
What is Medicare outpatient?
Per section 20.2 of publication 100-04 of the Medicare Claims Processing Manual, a hospital outpatient is a person who has not been admitted by the hospital as an inpatient but is registered on the hospital records as an outpatient and receives services (rather than supplies alone) from the hospital. Since CPT code 99490 will ordinarily be performed non face-to-face (see # 11 above), the patient will typically not be a registered outpatient when receiving the service. In order to bill for the service, the hospital’s clinical staff must provide at least 20 minutes of CCM services under the direction of the billing physician or practitioner. Because the beneficiary has a direct relationship with the billing physician or practitioner directing the CCM service, we would expect a beneficiary to be informed that the hospital would be performing care management services under their physician or other practitioner’s direction.
How many times can you bill Medicare for E/M?
Under longstanding Medicare guidance, only one E/M service can be billed per day unless the conditions are met for use of modifier -25. Time cannot be counted twice, whether it is face-to-face or non-face-to-face time, and Medicare and CPT specify certain codes that cannot be billed for the same service period as CPT 99490 (see #13, 14 below). Face-to-face time that would otherwise be considered part of the E/M service that was furnished cannot be counted towards CPT 99490. Time spent by clinical staff providing non-face-to-face services within the scope of the CCM service can be counted towards CPT 99490. If both an E/M and the CCM code are billed on the same day, modifier -25 must be reported on the CCM claim.
Do you need to change billing practitioners for PFS?
No, as provided in the CY 2014 PFS final rule (78 FR 74424), a new consent is only required if the patient changes billing practitioners, in which case a new consent must be obtained and documented by the new billing practitioner prior to furnishing the service.
What is CCM?
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.
What patients qualify for CCM?
Although preventive care is beneficial for everyone, the Chronic Care Management program focuses specifically on Medicare beneficiaries who have two or more documented chronic conditions in their health records.
Who is allowed to provide CCM?
A wide variety of qualified health care professionals are able to provide Chronic Care Management services. This includes physicians as well as non-physician practitioners such as clinical nurse specialists, nurse practitioners, and physician assistants.
What are the requirements of CCM services?
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.
What are the billing requirements of CCM?
CPT code 99490 can be billed for the initial twenty minutes of non-face-to-face care provided and documented for the patient each calendar month.
How often can you use CCM CPT code 99439?
CCM CPT Code: 99439 can be used every month. Instead of the required 20 minutes of care provided by a provider or QHP, it is 30 minutes of additional care. For patients to qualify, they must have two or more chronic conditions expected to last at least 12 months or until death.
What is the CCM code for 99491?
CCM CPT Code: 99491 can be used every month. There is a requirement of 30 minutes of care conducted by a provider or QHP instead of the 20 minutes. The same exact requirements remain the same for this CPT code.
What is the CCM code for 90 minutes of care?
CCM CPT code: 99489 is used when there is an additional 30 minutes of care. This code is seen with CPT codes: 99487. When this code is used, a patient will receive 90 minutes of care in the calendar month. This code is used when there is substantial revision that needs to be made to the patient’s care plan.
What is the difference between CCM and CPT?
Standard CCM can be distinguished from complex CCM by the respective CPT code. Complex CCM uses codes 99487 and 99489. Complex CCM patients’ care teams must have a significant establishment or revision of the care plan and typically communicate more with the care team staff in a calendar month.
How long does a CPT code last?
The main elements of this CPT code include two or more chronic conditions, which are expected to last 12 months or until the death of a patient. These chronic conditions have to place the patient at severe risk of death, worsening conditions over time, and functional decline.
What is CPT code?
Current Procedural Terminology (CPT codes) are numbers assigned to every task and service a provider administers to a patient, including medical, surgical, and diagnostic services. Insurers use these codes to determine the amount of reimbursement that a practitioner will receive from an insurer for that service.
How long does a patient have to be on CCM?
To qualify for CCM, a patient must have two or more chronic conditions anticipated to last at least 12 months or until death. Chronic conditions can put the patient at severe risk of death, worsening of conditions, functional decline are all qualifying factors for CCM.