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In January of 2015, CMS began allowing providers to bill $42* /patient for chronic care management under CPT code 99490. The code offers medical practices new, reoccurring revenue, often for work they already do while improving outcomes.
The Centers for Medicare and Medicaid Services has slowly been transitioning from a fee-for-service to value-based reimbursement model.
Many Medicare patients have numerous chronic conditions, multiple physicians, and a variety of treatment plans. 99490 incentivizes one provider to take the lead and coordinate care with multiple caregivers. This lead receives a hefty reimbursement while increasing efficiencies, and improving care and outcomes.
Physicians and the following non-physician practitioners may bill the new CCM service:
• Clinical staff working under the general supervision of an eligible practitioner
• Certified Nurse Midwives
• Clinical Nurse Specialists
• Nurse Practitioners
• Physician Assistants
If two practitioners within a practice both provide CCM for the same patient, only one may bill each month.
Practitioners must complete a comprehensive care plan and spend 20 minutes per month of non face-to-face time on care coordination activities such as:
• Follow-up calls
• Medication reconciliation
• Monitoring patient-care plans
• Follow-ups after an ER visit
• Consulting with other providers over test results
In addition, the patient must have 24/7 access to the provider
The patient must:
Medicare’s current ruling has patients with no secondary with a $8/month co-pay. Most patients will see the value of enhanced patient-provided communication and improved health outcomes. With a drop in number of office visits and decrease in health-related costs, the patient can also see the copay as a net positive.