Billing Rules for CPT 99490 & Other Chronic Care Management Codes

Chronic Care Management (CCM) plays an efficient role in managing the health of patients suffering from multiple chronic conditions. Chronic Care Management (CCM) services are non-face-to-face services provided to Medicare beneficiaries who have two or more chronic conditions expected to last for at least one year or until the patient’s death.

The Centers for Medicare and Medicaid Services (CMS) acknowledge that CCM services are critical components of primary care and promote better health while lowering the healthcare costs. CCM enables clinicians and healthcare organizations to give ongoing care to patients via remote interactions.

Here’s a brief guide to chronic care management and billing rules for CCM CPT Codes:

Medicare reimburses the CCM program if at least 20 minutes of patient service is performed each month. To be eligible for CCM, a patient must have two or more chronic conditions, and the physician must report any chronic illnesses a patient experienced 12 months prior to CCM enrolment.

1. CPT Code 99490

This non-complex CCM is a 20-minute timed service provided by clinical staff once a month to coordinate treatment among healthcare providers and increase patient engagement. The reimbursement rate for this in 2024 is $64 (the amount varies for different locations). The billing criteria includes:

• Multiple (two or more) chronic diseases expected to continue for at least 12 months or until the patient’s death.
• Chronic conditions that put a patient at high risk of death, acute exacerbation, or functional decline.
• A comprehensive care plan needs to be developed, implemented and amended based on ongoing treatment.

2. CPT Code 99439

This is an add-on code for 99490 and is billed in conjunction with it. Each additional 20 minutes of clinical staff time for CPT Code 99439 led by a physician or other qualified health care professional is reimbursed at a rate of $48 per calendar month (the amount varies for different locations).

3. CPT Code 99491

Under CPT Code 99491, CCM services provided by a physician or other health care professional are reimbursed for $86 for at least 30 minutes per calendar month (the amount varies for different locations), subject to the following conditions:

• Multiple chronic diseases are expected to last for at least a year or until the death of the patient.
• Chronic conditions that put a patient at risk of death, acute exacerbation, or functional decline.
• A comprehensive care plan needs to be developed, implemented and amended based on ongoing treatment.

4. CPT Code 99437

The CPT Code 99437 is an add-on code for 99491 is reimbursed for $61 (the amount varies for different locations). Chronic care management services are provided every 30 minutes by a qualified health care provider, clinician, or physician during a calendar month.

How Do I Bill For Chronic Care Management?

Billing for CCM requires meeting the following criteria:

• Patients with at least two chronic illnesses.
• Chronic conditions are predicted to last at least a year, or until the patient’s death.
• There should be a detailed care plan.
• A minimum of 20 minutes of care service is provided per month.
• The patient’s agreement is on file for undertaking chronic care.

CPT Code 99490 is used for billing chronic care management. It involves time spent providing comprehensive care coordination, reviewing lab or imaging results, and communicating with patients, caregivers, and other healthcare providers.

Embrace Chronic Care Management With HealthArc

Every individual is different and so are their medication and care needs. With HealthArc’s Chronic Care Management System, we formulate a customized treatment plan with comprehensive assessment to assist our patients in returning to their baseline body functioning.

Want to know how our digital health platform can maximize reimbursement and patient outcomes? Book a free demo or contact us at +201 885 5571 to learn more about our healthcare software.