Chronic Care Management is unquestionably a great way to support patients with chronic conditions in your practice. In 2015, Medicare began providing reimbursement for chronic care management with CPT Code 99490. Now, there are 5 different CCM CPT codes.
When healthcare providers work with patients to develop a care plan and deliver regular care services in the form of education and support, outcomes improve. These patients are more likely to use recommended therapies, make fewer trips to the Emergency Department, and spend less time in the hospital. If you are like most practices, you likely already offer this type of support at some level because it is a proven benefit for your patients. However, you may not be receiving the full reimbursement that is available to you for your time and effort.
Establishing a chronic care management program at your practice can help you connect eligible patients with the services they need. It can also boost profit for your practice and help you streamline your Medicare submission process.
To get those kinds of benefits, you’ll need to start with a clear understanding of the CPT codes that Medicare uses for chronic care management.
CPT Codes for Chronic Care Management
Medicare’s chronic care management program offers reimbursement for the time you spend providing non-face-to-face care to eligible patients. The reimbursement process uses four primary CPT codes and an HCPCS code for initial enrollment. Two of those codes apply to non-complex care services and two apply to complex care.
Let’s take a look at what each code covers and how they differ.
Enrollment Visit– HCPCS G0506
HCPCS G0506 can be billed when the provider enrolls the patient in-office and personally puts together a comprehensive care plan for a patient enrolling in chronic care management. This visit is not required for patient enrollment and is billed separately from CCM services.
Non-Complex Care CCM CPT Codes: 99490 and 99491
Non-complex care uses two codes for Medicare billing:
CPT Code 99490 – This is the most frequently used code for chronic care management. It is used for patients who require at least 20 minutes of chronic care management services per calendar month as directed by a health care provider.
To qualify, patients must have at least two chronic conditions that are expected to last at least twelve months; their conditions must place them at increased risk of death, acute exacerbation, or functional decline; and they must require the establishment, implementation, revision, or monitoring of a comprehensive care plan. They must also have had a visit with the provider in the past year.
CPT Code 99491 – Medicare added this code in 2019 to include patients whose care must be personally provided by a physician or qualified healthcare professional rather than by clinical staff. These patients must meet all of the same requirements as those covered by CPT 99490 and must receive at least 30 minutes of care per calendar month.
Complex Care CCM CPT Codes: 99487 and 99489
Complex care codes apply to patients who require a higher level of care management:
CPT Code 99487 – In addition to the requirements for non-complex care, complex care patients require the establishment or significant revision of their care plans; their care requires moderate or highly complex medical decision-making; and they must receive at least 60 minutes of chronic care management services per calendar month. Care may be offered by a clinical staff member and overseen by a physician or qualified healthcare provider.
CPT Code 99489 – This code may be used in conjunction with CPT code 99487 for each additional 30 minutes of care services. To be eligible, the patient must receive at least 30 additional minutes of services during a calendar month.
The difference between non-complex and complex CCM CPT codes is in the duration of care provided, the complexity of care planning, and the involvement required by the billing practitioner.
Is a Chronic Care Management Program Worth the Investment?
Establishing a chronic care management program may initially seem costly and complicated. For example, there may be some startup costs if you need to update your technology to meet documentation and submission guidelines. You will also need to present the program to your patients and help them enroll.
But the benefits of the program far outweigh the initial cost to get started. With the right approach, a chronic care management program can help you make sure every patient receives the care services they need to ensure the best possible health outcomes. It can also significantly boost the profit for your practice, especially if your staff already provides these services without reimbursement.
There are four keys to creating a profitable program:
- Not placing an additional burden on your internal staff
- Ensuring good enrollment
- Having adequate technology to meet submission guidelines
- Using CPT codes correctly to receive all eligible reimbursement
Meeting those four criteria may be difficult if your clinical staff is already working at full capacity, or if your technology will need an upgrade to participate. If that’s your situation, you may get the best results by partnering with a third-party chronic care management provider like HealthXL®.
At HealthXL®, we lift the burden of establishing and running the program off of your shoulders completely. We offer patient-centered, practice-friendly care partnerships that deliver quality care services while also helping you streamline your processes and boost profit.
Contact us to schedule your consultation today!