Chronic Care Management (CCM) CPT 99490

On January 1, 2015, Medicare began reimbursing practitioners for providing non-face-to-face services to patients with 2 or more chronic conditions via the CCM CPT code 99490.  Reimbursement for this code will vary by region, but on average it will be approximately $42 per  provider.   This code can be billed monthly as long as 20 minutes or more of non-face-to-face services have been provided by the practitioner or eligible clinical staff member (e.g., Registered Nurse).

The revenue potential of this program will be significant.  For example, if a practitioner enrolls 400 patients in the CCM program this would translate into $201,600 in additional revenue per year.   Medicare estimates that approximately 2 of every 3 Medicare recipients have 2 or more chronic conditions, so this number may be conservative for many providers.

What’s the Catch?

There are a number of requirements that need to be met before practices can bill for this code.  In addition, given the amount of revenue that will flow into the hands of practitioners we anticipate that the program will be closely monitored.  Several nuances of the program could create challenges for practices in the area of process management, workflow, and compliance.  For this reason we are offering to provide low-cost assistance to practices as they set-up and maintain a CCM program.

The following list provides an overview of what is needed:

  1. A mechanism for identifying patients who are eligible for the CCM program
  2. An EHR that has been certified by the Office of the National Coordinator of Health Information Technology (ONC-CERHT)
  3. A process for recruiting and enrolling patients in the CCM program, including a consent form
  4. A process for developing a comprehensive electronic care plan for each patient, something that most EHRs do not support
  5. A process for maintaining the comprehensive care plan when changes are made to the patient’s health status or plan of care
  6. A process that ensures that clinical staff members are eligible to provide CCM services under state licensure requirements
  7. A mechanism for documenting time spent and the nature of the interaction when staff provide non-face-to-face services
  8. A mechanism of identifying when a patient has reached the 20 minutes threshold for CCM services
  9. A method for providing the comprehensive care plan electronically to all providers involved with the patient’s care, even those who are not members of your practice
  10. 24/7 coverage access to the practice by the patient to a provider who is a member of the patient’s care team.  Contracted practitioners that provide after hours coverage may meet this requirement but certain restrictions may apply
  11. The ability to export and share an electronic health summary document with all practitioners involved with the patients care
  12. A process whereby your practice will play an active role in transitions of care
  13. A process whereby your practice will be prepared for audits that may occur several years after you start providing CCM services

Further information on the CCM program is available at: Medicare’s CCM Program: Opportunities and Challenges.

HCIT Consulting can provide low-cost assistance with setting up and maintaining your CCM program.  Email us for more information at info@hcit.consulting .