New Billing Codes for Chronic Care Management Attract Specialists

Posted on  September 5, 2017


In 2015, the Centers for Medicare and Medicaid Services (CMS) recognized the need for Chronic Care Management (CCM) services.  In response to the overwhelming research showing the impact that CCM was having on patients around the world, they introduced billing code 99490.  Though the reimbursement rates vary from state to state (some as high as $50 and others as low as $38), the national average is currently $40.83, per patient, per month.

In the beginning, the majority of providers that offered CCM services were general practitioners.  However, in 2017, CMS introduced additional billing codes that made adding CCM services to your practice more appealing for specialists.  These codes are specifically for “complex” CCM services and are CPT 99487 and CPT 99489.  The difference between these codes and their predecessor is the amount of time needed to provide sufficient services in cases that are more complex in nature.

CPT 99487 follows the same guidelines wherein eligible patients must have two or more chronic conditions that are placing them at risk.  However, it branches from there to require the establishment or revision of a comprehensive care plan where at least a moderate level of complex decision making is required and a minimum of 60 minutes (versus 20 minutes) of clinical staff time is needed to carry out the monthly care management.

Additionally, CMS added CPT 99489 to allow clinicians to bill for any time beyond the first 60 minutes of time needed at 30-minute intervals.  This billing code is not allowed to be used with the original CPT 99490.  It can only be used in complex cases as an additional code for CPT 99487 and must be listed separately when being used.

Though the reimbursement rates vary by state, CPT 99487 is often twice the rate of CPT 99490 while the additional 30 minutes is only slightly higher.  However, eligible clinicians who can provide complex CCM services remain the same: Physician Assistant; Nurse Practitioners; Clinical Nurse Specialists; and Certified Nurse Midwives.

It is important to note that only one practitioner may bill for CCM services per patient, in the given calendar month.  Therefore, specialists who choose to offer the service must first confirm with the patient that they are not already receiving CCM through another provider.  Additionally, the provider billing for CCM can only bill for non-complex or complex CCM services, not both.  You can learn more about complex CCM services by reading this informational piece provided by the Department of Health and Human Services in conjunction with CMS:  Complex CCM

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