CPT code 99490 is used for chronic care management (CCM) services that support ongoing, non-face-to-face care for patients with multiple chronic conditions. Here’s what you should know:
Eligibility: Patients must have at least two chronic conditions that are expected to last 12 months or longer, or that place them at significant risk of death, acute exacerbation or decompensation, or functional decline.
Services Covered: The code includes at least 20 minutes of clinical staff (e.g. Medical Assistant) time non-face-to-face care, including health monitoring, medication management, and care coordination directed by a physician or other qualified health care professional, per calendar month via phone communication.
Billing Frequency: CPT 99490 can be billed monthly, as long as at least 20 minutes of care is provided during that month.
Documentation: Accurate documentation is essential, including a care plan, patient consent, and time spent on care.
Discussion during a phone check-in with the patient and caregiver:
Monitor ADLs: Dressing, eating, personal hygiene, medication management, and daily routines.
Monitor for symptoms: Agitation, confusion, and depression.
Assess Caregiver Well-being: Physical and emotional health.
Offer Resources: Caregiver support groups, respite care.
Provide Training: Assistance with medications, daily tasks, and managing Alzheimer’s behaviors.
Review Care Plan: Monthly check-ins to assess cognitive/physical status, medication adherence, and caregiver needs.
Once a cognitive impairment care plan (CPT 99483) or diagnosis is established for conditions like Alzheimer’s disease and related dementia, CPT 99490 can be used for ongoing monthly management, particularly when a patient also has another chronic condition.
Billing Considerations:
The National Medicare approved amount for CPT 99490 is $66.13 (check rates for your locality).
Physicians, certified nurse midwives (CNMs), nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) are eligible to bill for CCM services once clinical staff (such as a medical assistant) documents a minimum of 20 minutes of phone communication, directed by a physician or another qualified healthcare professional, each calendar month.
NOTE: Primary care practitioners most often bill CCM services, but some specialty practitioners may also provide and bill them.
Patient Cost Sharing: Medicare may apply coinsurance for CCM services. Practices should inform patients of any potential cost sharing when obtaining CCM consent.
CPT 99490 is intended to support ongoing care coordination for patients with complex chronic conditions. Providers should ensure services meet Medicare requirements and are appropriately documented.
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