CPT Code 99490 For Billing Chronic Care Management (CCM) Services

Chronic Care Management

More than 40% of the US population suffers from chronic conditions. As per the Centers for Medicare and Medicaid Services (CMS), chronic conditions are defined as those diseases that put the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, and are expected to last until the patient’s death.

To deal with this healthcare problem, a remote care program was introduced in 2015, known as non-complex Chronic Care Management (CCM) program, invoiced under the new CPT code 99490. The program serves Medicare individuals with two or more chronic diseases and is administered in a non-face-to-face setting. With an emphasis on care coordination, the goal of a CCM program is to keep chronic illnesses in control, avoid unnecessary hospitalizations and ED visits, and save patients and Medicare thousands of dollars every year.

What Is CPT Code 99490?

CPT 99490 is a non-complex CCM code that covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. The average reimbursement rate for this code in 2024 is $64 (the amount varies for different locations). The billing criteria include:

  • 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.

To bill for the 99490 CPT Code, a clinician must first obtain documented patient agreement to participate in the program, demonstrating that the patient understands and agrees to pay associated copays and deductibles for the service.

Coding Requirements To Bill CCM CPT Code 99490

  • Patient’s consent (verbal or signed)
  • Personalized care plan in a certified EHR, with a copy sent to patient.
  • Patients have 24/7 access to a member of the care team for urgent needs.
  • Improved non-face-to-face communication between patients and care teams, as well as effective care transition management.
  • Clinical staff must spend at least 20 minutes per month on non-face-to-face CCM services directed by a physician or qualified health care professional.

Documents and reports generated in the patient’s medical record should indicate that the patient’s chronic conditions fulfill the standards set by the CPT narrative and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

Examples of chronic conditions covered under CCM CPT Code 99490 include:

  • Asthma
  • Cardiovascular disease
  • Diabetes
  • Hypertension
  • Arthritis
  • Cancer
  • COPD
  • Alzheimer’s disease
  • Depression
  • Autism
  • Atrial Fibrillation
  • Alcohol dependence
  • Stroke
  • Anxiety disorders
  • Heart failure
  • HIV & Aids
  • Infectious diseases
  • Anemia
  • Autoimmune conditions
  • Chronic kidney disease
  • Hyperlipidemia
  • Ischemic heart disease
  • Obesity
  • Chronic Obstructive Pulmonary Disease
  • Osteoporosis

Billing Criteria For CPT Code 99490

  • Providers cannot bill 99490 more than once per month.
  • The CCM services indicated by CPT codes 99491 and 99437 cannot be billed with 99490.
  • CPT 99490 cannot be billed for time less than 20 minutes.
  • In case of service provided for more than first 20 minutes, CPT code 99490 necessitates an add-on code 99439 for each additional 20 minutes.

Once enrolled, CCM services require 20 minutes of clinical staff time each month for the patient, which must be documented in a detailed care plan. That care plan must be made available to all healthcare practitioners involved in the patient’s care continuum on a monthly basis.

Frequently Asked Questions on CCM CPT Code 99490

  1. Who can bill Chronic Care Management CPT Code 99490?

A clinical staff member can legally provide medical services under the supervision of a physician, physician’s assistant, or nurse practitioner. CCM services can be billed by both physicians and non-physician practitioners, including clinical nurse specialists, nurse practitioners, physician assistants, and certified nurse midwives.

  1. Can CCM be billed on the same day as a provider office or hospital visit?

You can bill CCM on the same day as a provider office or hospital visit, but you must utilize the 25 modifier. You can bill CCM and emergency or medical visits on the same day as long as the service time is counted once. If you bill both the CCM code and an emergency or medical visit on the same day, you must include modifier 25 on the CCM claim.

  1. What date of service should be included in the claim? 

The right date of service for your claim is the day you meet 20 minutes of billable time. Every second and minute you spend on care coordination of the patient is added towards the 20 minute block. However, you may use different dates as long as 20 minutes of billable time are performed on or before the last day of the billing month.

  1. Can a provider bill more than one CCM claim for a patient every calendar month?

Providers may only bill one CCM claim each month. This is because CCM claims must be made at least 30 days apart.

  1. What codes cannot be billed in the same month as CCM?

Qualified healthcare providers cannot bill for CCM services while another facility or practitioner provides care management.

  1. What are the steps involved in billing 99490?
  • Use 99490 for 20 minutes of service.
  • The location of service should be mentioned as the provider’s office or location code 11.
  • Bill for Medicare Part B.
  • When invoicing, use the “Date of Service” as given in the clinical record.
  • If you receive a denial because the patient was at the hospital or provider’s office on the day they were billed for CCM, you may alter the CCM date to the next day without penalty.
  • If a patient has a Medicare Advantage plan as primary and Medicare as secondary and receives a denial from the Medicare Advantage plan, you may submit billing to Medicare for reimbursement.
  1. Can 99490 be billed for inpatients?

If the location of residence is an assisted living or nursing home facility, then possibly yes. You will need to determine how the patient is registered. If the facility receives Part A, you cannot bill for CCM services. Instead, use 99307, 99308, or other home health certification codes.

  1. Do Medicare Advantage plans pay for 99490?

MA plans should pay unless they are enrolled in a capitated Advantage plan.

  1. Is patient consent needed every month?

Patient permission is only required once, prior to administering the first CCM service. However, if the patient opts for a new provider who bills for CCM, the patient must sign a new consent form with that provider.

  1. Is there a code that cannot be billed in the same month as 99490?

Yes. These codes include:

  • Transitional Care Management – 99495, 99496
  • Home Healthcare Supervision – HCPCS G018
  • Hospice Care Supervision – HCPCS G9182
  • Certain ESRD Services – CPT 90951-90970

Choose HealthArc’s CCM Platform For CPT 99490 Billing

With HealthArc’s Chronic Care Management platform, we help healthcare providers in formulating a personalized care plan to help patients recover to their baseline bodily functioning.

Do you want to know how our digital health platform may improve reimbursement and patient outcomes? Book a free demo or call us at +201 885 5571 to learn more about our CCM software.