Chronic Care Management (CCM) is not a new phrase, and it is likely that your organization is at least vaguely familiar with what all it entails. In order for CCM to come into play, a patient must have two or more chronic conditions, only one provider can bill for that patient, and copayment do apply. Now, for this entry, let’s shift our focus on implementing chronic care management for CPT code 99490.
CPT Code 99490 is for Medicare patients that have several chronic illnesses. In order to bill using this code, the interactions are non-face-to-face. Several codes cannot be billed for in the same month as CPT 99490, they are as follows…
- Transition Care Management (TCM) – CPT 99495 and 99496
- Home Healthcare Supervision – HCPCS G0181
- Hospice Care Supervision – HCPCS G9182
- Certain ESRD services – CPT 90951-90970
Now, let’s talk about how to implement CCM and bill for CPT 99490…
Identifying Eligible CCM Patients
When starting your practice’s CCM journey, begin by focusing on specific diagnoses. Some examples of what these could include are diabetes, COPD, arthritis, or dementia. After you determine patients that have two or more of these chronic conditions, begin to contact them. You may choose to do this through an outreach campaign via phone or email, or directly to the patient during their next scheduled appointment. We recommend that a phone line be designated specifically for chronic care patients. Though this, after hours calls can be forwarded to the correct clinician and the line can be answered by staff members knowledgeable about the CCM program.
Education is key when it comes to CCM. Make sure that patients remain educated on what the program entails, what value it holds, and their options for participation. Patients can decline, transfer, or terminate their participation at any time throughout this. Participants need to know their options and how to go about terminating their participation. Other items that make patients knowledgeable of include…
- The patient’s obligation with copayments and deductibles
- The nurse’s schedule for monthly over the phone assessments
- Electronic communications that will occur throughout the program (and if they authorize it)
- Who the designated physician is and CCM nurse
Engaging with your patient inevitably leads to better adherence to the care plan discussed during visits. These care plans need to be patient centered and focused on the patient’s individual mental, physical, functional, and emotional assessment. This care plan should be shared with others on that patient’s care team, and with the patient. The best way to do this may be through using the patient portal. Utilizing a patient portal is a low cost, efficient way to share documents and communicate with patients throughout this process. Providers should document the time spent on non-face-to-face services spent coordinating care, answering emails/phone calls, and on prescription management with each patient.
Billing for CCM
Before submitting a bill for reimbursement for CCM services, providers (or staff members in charge of billing) should ensure that the requirements were met for CCM for each patient. From there, a bill for CCM reimbursement can be submitted for CPT 99490.
Through continuous care with their care provider, patients with chronic illnesses can enjoy a better quality of life with less pain. Providers, with CCM, you can be a larger part of this process and see a reimbursement along the way.