Nuts and Bolts

CCM Nuts & Bolts

CMS finalized CPT 99490 as a monthly code with a national allowed amount of $42.60 effective January 1, 2015. This code provides payment for your practice’s chronic care management services that are provided to eligible patients.

CMS requires 20 minutes per calendar month of documented clinical staff time directed by a physician or other qualified healthcare professional and the following:

  • Patient must have 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;
  • A comprehensive care plan be established, implemented, revised, or monitored.

CMS elements of service for coverage include:

  • 24/7 access to care;
  • Continuity of care with a designated team member;
  • Creation of a comprehensive patient-centered care plan based on physical, mental, cognitive, psychosocial, functional, and environmental assessments;
  • Management of chronic conditions, including system-based approaches to ensure timely receipt of all recommended preventive care services, medication reconciliation with review of adherence and potential interactions, oversight of patient self-management of medications, and systematic assessment of the patient’s medical, functional, and psychosocial needs;
  • Management of care transitions between and among healthcare providers;
  • Coordination with home and community-based clinical service providers;
  • Enhanced opportunities for beneficiary and caregivers to communicate with practitioner regarding beneficiary’s care.

CMS also requires:

  • Documented beneficiary consent and the 20% beneficiary coinsurance applies;
  • Only one Part B provider to be paid for the CCM in one month;
  • Use of a certified EHR in addition to other scope of service elements.