An update to the blog, “Maximizing Care and Reimbursement with Chronic Care Management Codes“
CMS explains chronic care management (CCM) as a critical component of primary care that contributes to better outcomes, reduces overall health care costs and helps achieve higher patient satisfaction. CCM services are extensive, which includes face-to-face E/M visits, structured recording of patient health information, 24/7 access & continuity of care, keeping comprehensive electronic care plans, managing care transitions and other care management services, home- and community- based care coordination, enhanced communication opportunities, and medical decision making. CCM services provided can be documented accurately on the medical claims and submitted on time to insurers, with the support of professional medical coding companies.
Chronic conditions mainly include Alzheimer’s disease and related dementia, Arthritis (osteoarthritis and rheumatoid), Asthma, Atrial fibrillation, Autism spectrum disorders, Cancer, Cardiovascular disease, Chronic Obstructive Pulmonary Disease (COPD), Depression, Diabetes, Hypertension, and Infectious diseases like HIV and AIDS. Physicians and non-physician practitioners (NPPs) who may bill for CCM services include Certified Nurse Midwives (CNMs), Clinical Nurse Specialists (CNSs), Nurse Practitioners (NPs), and Physician Assistants (PAs). Under CCM, at least 20 minutes of patient service must be provided each month for Medicare to offer reimbursement.
Chronic Care Management (CCM) CPT Codes for the Year 2022
Here’s a list of relevant CCM CPT codes and their descriptions, applicable in 2022 (Health Recovery Solutions).
99437 Subsequent 30 minutes of care personally provided by a physician or NPP
- CPT 99437 is an add-on code to CPT 99491 for additional time beyond the initial 30 minutes of care covered by 99491.
- Similar to CPT 99491, all care must be provided personally by a doctor, NP, or other qualified healthcare professional to qualify for reimbursement under CPT 99437.
99439 Subsequent 20 minutes of care provided by clinical staff
- Beginning 2022, CMS has replaced G2058 with 99439
- Combined with CPT 99490, CPT 99439 can be used every month for additional 30 minutes of care provided for non-complex CCM performed by clinical staff, with supervision of a doctor.
99487 Minimum 60 cumulative minutes over a 30-day period of non-face-to-face consultation time establishing or monitoring a care plan.
Other requirements and patient services needed to qualify for CPT 99487 reimbursement are:
- More than one chronic condition expected to last at least 12 months, or until the death of the patient.
- Chronic conditions that place the patient at a significantly higher risk of death, acute exacerbation/decompensation, or functional decline.
- Establishment or revision of a comprehensive care plan.
99489 To be billed with CPT 99487 for every additional 30 minutes of non-face-to-face consultation
- CPT 99489 can be used as an add-on code to CPT 99487 for additional time spent on care coordination services per calendar month
- While CPT 99487 reimburses the first 60 minutes of a non-face-to-face consultation, CPT 99489 reimburses each additional 30 minutes spent on a session
- Introduced in 2017, this code points out the fact that complex chronic care management patients often require several hours of non-face-to-face care coordination per month
99490 Minimum 20 cumulative minutes over a 30-day period of non-face-to-face time monitoring the care plan
- CPT 99490 allows non-face-to-face monitoring and non-complex CCM carried out by clinical staff, under the supervision of a doctor, to be reimbursed.
- The focus of this code is on reimbursing service for patients with two or more chronic conditions, preventing the escalation or worsening of these conditions.
- Requirements to qualify for CPT 99490 are the same as CPT 99487, apart from a lower minimum time of 20 minutes of provided care.
99491 Initial 30 minutes of care personally provided by physician, or non-physician practitioner (NPP)
This code is an add-on to code 99490 with similar patient eligibility criteria of two or more chronic conditions, a significant risk of death, acute exacerbation, or functional decline and the establishment of comprehensive care.
The differentiators between the two codes are that CPT 99491 requires:
- CCM services to be provided personally by doctors and nurse practitioners
- A minimum 30 minutes of CCM care per month.
Other CCM CPT Coding Tips to Consider
- Do not bill 99491 and 99437 codes – when chronic care management is provided by medically directed staff only (use 99439, 99490), when less than 30 minutes of time is spent monthly, twice in one month, or when the service time has been reported as transitional care management services (99495-99496)
- Don’t report 99491 in the same calendar month as 99487, 99489, or 99490
- You can report CCM codes 99487, 99489, 99490 and 99491 by the same practitioner for services furnished during the 30-day TCM service period (CPT 99495, 99496)
- Never report complex CCM and prolonged Evaluation and Management (E/M) services in the same calendar month
Professional medical coding outsourcing service providers will be up to date with the changing CPT coding guidelines and they assign the right codes for the treatment provided.
Also read our earlier blogs on chronic care management