With Improved Patient Care Increase Your Revenue with our Chronic Care Management Program

Beginning January 1, 2015, Medicare started paying separately for chronic care management under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490. chronic care management program

Starting 2017, Medicare has introduced 2 more codes for reimbursement (CPT) code 99487 and (CPT) code 99489 for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.

Elements of CPT Code 99490 include:

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: `

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
  • Comprehensive care plan established, implemented, revised, or monitored.

CPT Code 99487

As of 2017, CPT code 99487 is reimbursed by Medicare to account for extended care coordination time spent with especially complex patients. This code reimburses for the first 60 minutes of non-face-to-face care coordination by clinical staff.

Elements of CPT Code 99487 include:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
  • Establishment or substantial revision of a comprehensive care plan
  • Moderate or high complexity medical decision making
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

The two major differences between CPT code 99487 and CPT code 99490 are the additional time, 60 minutes for CPT 99487 from 20 minutes for CPT 99490 and the requirement around medical decision making.

CPT Code 99489

Complex Chronic Care Management patients often require several hours of care coordination per month. Accordingly as of 2017, Medicare is reimbursing for additional non-face-to-face time spent by clinical staff on care coordination via CPT 99489. CPT 99489 is an add-on code for CPT 99487 that reimburses for each additional 30 minutes of care coordination services per calendar month (CPT 99497 reimburses for the first 60 minutes).


Examples of chronic conditions include, but are not limited to, the following:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Heart failure
  • Hypertension
  • Ischemic heart disease

Benefits Of Chronic Care Management

Med eSolutions was formed to assist physicians in overcoming the challenges of incorporating technology into everyday practice.

Physicians usually lack the time and staff required to provide the in-depth care management that their chronically ill patients need. While CMS reimburses providers for ccm services provided in the office, extending patient care beyond the office improves outcomes.

That is why, as of Jan. 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule, American Medical Association CPT Code 99490 for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.

This enables physicians to:

  • Better manage the chronic conditions for Medicare patients outside of regular of office visits.
  • Get more appointments with more pro-active monitoring & reminders for routine check up.
  • Take advantage of significant reimbursement dollars.
  • Enable patients to perceive higher levels of attention to their health.

Patient Eligibility

Patients who have multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline are eligible for the CCM service. chronic care management program


Patient Agreement Requirements 

The practitioner must inform eligible patients of the availability of and obtain consent for the chronic care management service before furnishing or billing the service. The patient agreement provisions require the use of certified Electronic Health Record (EHR) technology. chronic care management program

Patient consent requirements include:

  • Inform the patient of the availability of the chronic care management service and obtain written agreement to have the services provided, including authorization for the electronic communication of medical information with other treating practitioners and providers.
  • Explain and offer the chronic care management service to the patient. In the patient’s medical record, document this discussion and note the patient’s decision to accept or decline the service.
  • Explain how to revoke the service.
  • Inform the patient that only one practitioner can furnish and be paid for the service during a calendar month.

Resources www.cms.gov

 

To schedule your FREE demo today contact us NOW!

 

Back to top                                                                                                                                                                                                 Back to Home Page