CPT Code 99490 is the base Chronic Care Management code, established in 2015 to reimburse physicians for the extra time it takes to coordinate care for Medicare patients with multiple chronic conditions. Chronic Care Management is proven to help patients follow their provider’s care recommendations, improve their overall health and reduce their need for office, ED and hospital visits. With monthly guidance from their Care Coordinator, they receive the encouragement and resources they need to stay healthy.

What Services are Required?

In order to bill for CPT Code 99490, physicians must deliver the following services:

  • At least 20 minutes of clinical staff time
  • Directed by a physician or nurse practitioner
  • The creation and maintenance of an electronic comprehensive care plan, accessible to the patient 24/7

Who Qualifies for CPT Code 99490?

Patients qualify for chronic care management services if they have at least 2 chronic conditions that are:

  • Expected to last at least 12 months (such as diabetes, high blood pressure, arthritis, cancer)
  • Expected to place the patient at risk of serious harm, injury, or death, if not given regular appropriate treatment

Practices must document patient consent (verbal or written) in their EMR.

What is a Comprehensive Care Plan?

A comprehensive care plan serves as a running record of past medical history as well as a plan of action for current medical conditions. For chronic care management, this care plan must be in electronic form and accessible to patients 24/7 through the EMR.

CMS does not dictate the format of care plans, but does give a list of elements to include (page 8). HealthXL® care plans contain the following information:

  • Service summary with notes from each month of service by a care coordinator
  • Contact information for all members of the patient care team: primary care physician, specialists, HealthXL® care coordinator, and family caregivers
  • Diagnoses from the ICD-10 index
  • Medication List
  • Recent Symptoms
  • Monthly record of relevant vitals
  • Allergies
  • Health events: doctor’s visits, hospitalizations, lab work
  • Lifestyle notes
  • Health goals

At HealthXL®, our Care Coordinators use a proprietary software that guides each patient interaction, ensuring the same thorough service each month.

How Does Monthly Service Work for CPT Code 99490?

While Medicare does not prescribe the method of service for CPT 99490 beyond the requirements described above, HealthXL® has found that establishing a defined service method ensures consistency and quality of service. Each month, one of our clinical staff members (care coordinators) will review the patient’s records in the EMR, updating all appropriate sections of the care plan. They then reach out to the patient by phone, making additional attempts if the patient is not available.

Once connected with the patient, the care coordinator asks a series of questions related to the patient’s conditions, with the goal of detecting warning signs or changes needed to the plan of care. All information is recorded in the care plan for the provider’s reference. If patients have any health needs at the time, like medication refills, community services, or new appointments, the care coordinators inform the practice, per their workflows.

Are There Any Billing Limitations?

  • Cannot be billed concurrently with CPT 99497, 99491, or 99489
  • Certain home health services and hospice care performed by the same practitioner are not eligible for concurrent billing
  • Can be billed concurrently with RPM (CPT 99454, 99457 and 99458)

How Much Does Medicare Reimburse?

As of 2021, the average reimbursement for non-facility chronic care management services (CPT 99490 is $42.21.

Can A Third Party Deliver Services On Behalf of the Practice?

Yes, under the Medicare regulations, third party chronic care management partners may provide the clinical services for CPT 99490 under the supervision of a physician. Many providers find that using a third party partner helps them to deliver consistent and quality services without burdening their internal clinical staff. Third party partners like HealthXL® can streamline the process of identifying and enrolling eligible patients and can provide services at a scale most practices are not equipped to implement on their own.

Getting Help With Chronic Care Management Services

HealthXL® delivers easily-implemented Chronic Care Management and Remote Patient Monitoring Services to improve care for Medicare patients with chronic conditions. By combining consistent virtual monitoring, follow-up and accountability, our services are proven to improve patient care, streamline the healthcare process and boost practice revenue. Contact us today to find out more.