Blog

Your Guide to Maximizing Your CPT 99490 Reimbursement — 2024 Edition

General Chronic Care Management (CCM) services, billed under CPT 99490, help Medicare patients with multiple chronic conditions improve and manage their health. Medicare and Medicaid reimburse providers who offer CCM programs, because these programs reduce patient costs and healthcare spending by an average of $2,457 per patient. Even better, a wide variety of health care providers are eligible to provide CCM services and bill CCM codes.

This guide will cover how your practice can offer effective Chronic Care Management, maximize your reimbursements under CPT 99490, and provide more preventative care to your patients. 

What Is CCM Billing? 

Before billing for CPT 99490, providers should know what Chronic Care Management (CCM) is all about. CCM services are typically non-face-to-face services focused on assisting Medicare patients with two or more chronic conditions that are expected to last at least a year. Medicare’s increased focus on value-based care has shown the need for more preventative programs that address patients' health conditions before they worsen.

99490 is the code for the first 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month. If patients need more care and care managers provide 20 extra minutes of support beyond the initial 20, your practice can bill CPT code 99439. 99439 can be billed twice for patients who require 60+ minutes of care.

CCM services are critical to primary care because they benefit patients and healthcare systems by:

• Improving patient outcomes.
• Reducing healthcare spending.
• Decreasing hospital readmission rates.

In 2015, the Centers for Medicare and Medicaid Services (CMS) began reimbursing providers who offered CCM for their patients on a per month, per enrolled patient basis. Since then, the program has been proven to reduce hospitalizations by nearly 5%, reduce emergency department visits by 2.3% and increase preventative care E&M encounters by 8%. ChartSpan’s internal numbers also show 30-day hospital readmissions being reduced by 52%. 

CCM Patient Qualifications

Although preventive care benefits everyone, the Chronic Care Management program focuses on Medicare beneficiaries with two or more documented chronic conditions in their health records. CMS defines chronic conditions as those that increase a patient's risk of death, functional decline or acute exacerbation/decompensation and last for at least one year or the remainder of their life.

There is a long list of conditions that qualify, but some of the most common include diabetes, hypertension, depression and hyperlipidemia. Patients can only be enrolled in Chronic Care Management under one provider, and they must have visited the provider within the past year in order to not have an initiating visit. 

All patients must provide their consent to be enrolled in the program and are able to unenroll at any time. At this time, most patients will require a small monthly copay to remain in the program.  

Who Can Bill CCM Codes?

A wide variety of qualified health care professionals can provide Chronic Care Management services. Physicians and non-physician providers are eligible to bill CCM codes:

• Physician Assistants 
• Nurse Practitioners
• Clinical Nurse Specialists
• Certified Nurse-Midwives

While clinicians, nurses, health coaches, and more can perform general CCM functions, all medical decision-making is left up to the provider. Most frequently, primary care providers are the ones who offer CCM, but several specialties are also qualified to offer CCM, such as nephrology, urology, oncology, gastroenterology, and cardiology, among others. Limited-license practitioners and physicians, such as dentists and psychologists, cannot bill for CCM, but primary practitioners can consult with them to manage and coordinate care. 

What Are the Service Requirements for CCM?

To successfully bill for CCM services, providers must document a minimum of twenty minutes of clinical staff time per patient spent on care coordination. Care coordination activities include a wide variety of non-face-to-face care, from refilling prescriptions to coordinating transportation and appointments, follow-up, creation of care goals, and documentation of a care plan.

A comprehensive care plan is one of the core requirements of CCM that must be documented in the electronic health record (EHR). The plan can then be shared with the patients’ other current healthcare providers, as well as any caregivers, so that the patients’ healthcare network stays connected. CCM services are billable once per calendar month that the patient is enrolled. 

What Are the Billing Requirements of CCM? 

The CPT 99490 code can be billed for the initial twenty minutes of non-face-to-face care provided and documented for the patient each calendar month. Reimbursement for this service can vary by state and practice type. For example, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) are typically reimbursed at a higher rate than a standard practice and bill G0511 instead of CPT 99490. 

Additional Billing Requirements

In addition to 99490 or G0511, there are other CCM codes practices can choose to bill. Before billing for CCM monthly services (G0511) for the first time, RHCs and FQHCs  may elect to bill G0506, an add-on code used exclusively for initiating visits. Providers may only bill this code once, and they must list it separately as an addition to the primary service.

Traditional practices who provide continued care planning after the 20 minutes of billable time required for CPT 99490 within a month may be eligible to bill for 99439. 

Some practices are also eligible to bill for Complex Chronic Care Management, which has additional requirements for clinical staff time and a higher level of medical decision-making. Complex Chronic Care Management isn’t offered by many CCM vendors, so if you have a CCM partner, you should consult with them before attempting to bill these additional codes. 

Trust ChartSpan for All Your CCM Needs

ChartSpan offers the nation's largest full-service CCM program. With ChartSpan, you can provide your patients with 24/7 access to care management services. Our care team will act as an extension of your practice and reach out to enrolled patients for you monthly. Our full-service solution covers a wide range of important services, like Social Determinants of Health support and creating care plans, so you can focus on caring for patients. 

The ChartSpan team can also help you simplify a previously tedious billing process. ChartSpan's RapidBill Auto technology lets you bill CPT 99490 and other codes faster and easier, saving time for your billing team.

Our CCM solution improves patient outcomes and helps you work towards better quality scores, so you can encourage  Medicare patients to remain loyal to your practice. We help patients adhere to care plans and reach goals by providing 24/7 support and coordinating their care between you and their other providers. If you have any questions about Chronic Care Management and the billing requirements, reach out to us and we will be happy to help.

Contact ChartSpan for Optimized CCM Solutions

CCM services, like CPT 99490, reduce healthcare costs and improve patient health. With ChartSpan CCM solutions, you can provide your patients with dedicated preventative care while saving your practice time. Contact us to learn more about Chronic Care Management and its billing requirements.