CPT 99490, the primary CPT code used for Chronic Care Management, was introduced by Medicare January 1st, 2015 in an effort to coordinate care, improve clinical outcomes, and manage overall healthcare cost for Medicare’s most high risk patients – the chronically ill. Specifically CPT 99490 reimburses for:
Chronic Care Management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
- Comprehensive care plan established, implemented, revised, or monitored.
Key features of CPT 99490 include that the code:
- Can be billed “incident-to” the physician’s services and under “general supervision” requirements so that the program can be provided by a third-party care coordination company
- Reimburses for non-face-to-face time, meaning it supports telephonic or other remote care models
- Can be paid recurrently per patient per month provided that all the requirements are met in a calendar month
- Is a billable service for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
