One barrier to Chronic Care Management (CCM) has been the inability to bill for CPT 99490 in facilities such as hospitals and nursing facilities. As of 2016, CMS already opened up billing for 99490 in their Hospital Outpatient Prospective Payment System (OPPS). However, questions still remained around skilled nursing facilities (SNF) and other nursing facilities. The original guidance per AMA CPT for CCM stated that “these [CCM] management and support services are provided to patients who reside at home or in a domiciliary, rest home, or assisted living facility” resulted in a ambiguity about billing the code in skilled nursing facility and nursing facility (SNF/NF) settings. However, CMS recently published a FAQ that resolves some of these doubts around billing for Chronic Care Management (CCM) under CPT 99490.
One of the questions in this FAQ is:
“Can I bill CPT 99490 for CCM services provided to beneficiaries in skilled nursing facilities, nursing facilities or assisted living facilities?”
“If all the CCM billing requirements are met and the facility is not receiving payment for care management services (for example, the beneficiary is not in a Medicare Part A covered stay), practitioners may bill CPT 99490 for CCM services furnished to beneficiaries in skilled nursing facilities, nursing facilities or assisted living facilities. The place of service (POS) on the claim should be the billing location (i.e., where the billing practitioner would furnish a face-to-face office visit with the patient).”(1)
The practitioner, however still needs to meet ALL the requirements of the code including the electronic care plan. CareHarmony is in the process of partnering with physicians and physicians in nursing homes to provide these valuable services to patients.
- CMS, “Frequently Asked Questions About Billing Medicare for Chronic Care Management Services,” 2016, March 17. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Payment-Chronic-Care-Management-Services-FAQs.pdf