When Medicare announced in early 2015 it was adding the new CPT code 99490, it was a big win for chronic care management and telemedicine. 99490 was added specifically to provide better coverage for managing patients with multiple chronic conditions, a job that often requires a lot of “behind-the-scenes,” unbillable time for healthcare providers.
With about 2/3 of Medicare patients currently dealing with multiple chronic conditions and 86% of our healthcare spending going towards fighting chronic disease, tackling this area of our healthcare field is not easy. But adding the 99490 code is a good start.
So where does telemedicine fit into the CCM program?
Many healthcare experts have identified telemedicine as a key piece to alleviating the chronic care puzzle, since telehealth could help with treatment adherence, quick convenient check-ins with patients, and avoid expensive, avoidable hospital stays. Medicare seems to agree!
With Medicare’s CCM program, doing a telemedicine visit is just one of the ways to meet the requirements for billing the 99490 code.
Here are a few things you should know about how Medicare CCM program works.
- Medicare patients who have two or more chronic conditions qualify for the program.
- Possible qualifying chronic conditions include:
- And more
Providers can bill the CCM CPT code 99490 once a month, for a non face-to-face service.
The procedure needs to take at least 20 minutes of clinical staff time per month.
That service can be a video interaction between the patient and doctor via secure Internet (like with eVisit).
The following healthcare providers can bill the 99490 code:
- Certified Nurse Midwives
- Clinical Nurse Specialists
- Nurse Practitioners
- Physician Assistants
Only one provider can bill the 99490 per patient, per calendar month.
The CCM program is available through traditional and Medicare advantage programs.
The provider needs to have a certified EHR system.
Providers need to get a patient’s informed consent to initiate the CCM program. Here’s what you’ll need to do to get consent:
- Tell them about the CCM program
- Get their written agreement to participate in the program, and permit electronic communication of their medical information
- Describe how the patient can stop the service
- Make sure to say that only one provider can bill for the CCM service per calendar month
- The CCM scope of care includes a range of services, from simply recording patient’s demographic information in your EHR, to creating a comprehensive care plan.
Checkout this Medicare handout for the full list of included services.
- 99490 can’t be billed during the same service period as certain other codes.
Specifically, providers cannot bill 99490 at the same time as:
- 99495 – 99496 (transitional care management)
- G0181 – G0182 (home health and hospice care supervision)
- 90951 – 90970 (end-stage renal disease)
The 2015 payment rate for 99490 is $42.91 per month, per patient.
Still have questions about Medicare’s chronic care management program? Check out this handy FAQs sheet.
Plus, you can learn more about Medicare’s guidelines for telemedicine services on our Medicare and Telemedicine Reimbursement page!