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How to Meet CPT Code 99490 Requirements for Chronic Care Management & Get Reimbursed by Medicare

How to Meet CPT Code 99490 Requirements for Chronic Care Management & Get Reimbursed by Medicare

By Ron Ritchey, M.D., Chief Medical Officer

Chronic Care Management ReimbursementOne of the most significant pieces of federal stimulus for providers and Medicare beneficiaries, CPT code 99490, began on January 1, 2015. If you are interested in being reimbursed by the Centers for Medicare and Medicaid Services (CMS) and the ability to increase revenue by as much as $250,000 per year, please read on.

How to Qualify for Medicare Reimbursement With CPT Code 99490

At the beginning of this year, the Centers for Medicare & Medicaid Services began reimbursing chronic care management (CCM) services for qualified Medicare beneficiaries who have at least two chronic conditions expected to last longer than a year.

The reimbursement varies from state to state, as all Medicare fees do, but generally CMS reimburses at approximately $40 per beneficiary. Twenty minutes of non­-face-­to-­face care coordination management services per month for each beneficiary is required to qualify for reimbursement under the new CPT codes.

This fee can be charged once a month, every month, while the patient is living.

Chronic Care Management Reimbursement Code Implications

This is significant news. Under the new CPT code 99490, the physician can basically act as a supervisor of services. While the practitioner bills for the care provided, the actual “behind the scenes” care coordination services are provided by a nurse or other type of aide. So it does not really require any significant amount of actual physician time.

For years, Medicare has been trying to figure this issue out. Over the years, all parties (including CMS) have acknowledged that the type of care coordination we provide at eQHealth Solutions is worthwhile, and helps patients. Both patients and physicians are satisfied with these types of services. Now, there is a mechanism where the physician can get paid as he goes. In my opinion, this will dramatically increase the demand for care coordination, because now there is a way to pay for it.

What Can You Do to Take Advantage of the New Code?

So what are the next steps? To take advantage of CPT code 99490 and qualify, the first thing to do is get a written consent form from the beneficiary. Secondly, any physician or physician practice must ensure they have the capabilities to provide the CCM services.

Requirements for Providing Chronic Care Management Services

  • Utilize a certified electronic health record (EHR)
  • Execute 20 minutes of non-­face-­to-­face services per month by physician or care team
  • Ensure 24-­hour access to care management team in a timely manner
  • Coordinate care through qualified providers
  • Facilitate transitions of care
  • Maintain a customized electronic plan of care tailored specifically to the patient

Coordinating Your Chronic Care Management Program

Setting up chronic care management will require some investment, so we encourage the engagement of an experienced partner to help navigate the nuts and bolts of implementing a successful care coordination program. If you have ever wanted to set up such a program but were not sure how to pay for it, we strongly encourage you to investigate this new offering.

eQHealth Solutions can aid in setting up your Chronic Care Management Program with both our technology and services solutions. Our goal is to help improve the health of your patients while growing your practice revenue and profitability. Our Chronic Care Management Program is designed to be a turnkey solution for provider practices and other organizations seeking to take advantage of CPT Code 99490. Our community-based nursing services (eQCare®) and robust care management technology (eQSuite®) offer a complete solution for executing and billing for CCM services.

CCM Success Guide

Have any questions? Call us toll-free.1-800-720-2578
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