Four new billing codes are now available for physicians who care for the 117 million adults with multiple chronic health conditions. CMS’s new chronic care management codes are intended to improve outcomes and compensate physicians for the additional time spent managing these complex patients.
The codes recognize that primary care contributes to better health and allow practices to seek separate payments for CCM services, says Nick Schilligo, AOA vice president of public policy. Some two-thirds of Medicare recipients have two or more chronic conditions and might benefit from participating in a CCM program, according to CMS.
- The Medicare patient must sign an agreement stating they wish to receive chronic care management services, and they must have two or more chronic conditions expected to last at least 12 months.
- Each calendar month, a physician or another qualified health care professional must spend at least 20 minutes providing non-face-to-face care.
There are four codes associated with chronic care management services:
- CPT code 99490: Allows health professionals to bill for 20 minutes of non-face-to-face care provided to a Medicare patient with two or more serious chronic conditions.
- HCPCS code G0506: This code is an add-on to the chronic care management initial visit and reflects time spent giving patients a thorough assessment and care planning.
- CPT code 99487: Use this code for complex chronic care management services that require 60 minutes of clinical staff time and involve substantial changes to a care plan with moderate- or high-complexity medical decisions.
- CPT code 99489: This is an add-on code for each additional 30 minutes of clinical staff time spent on complex chronic care management.
To learn more, check out the CMS guide to chronic care management codes and view answers to frequently asked billing questions. CMS also offers a toolkit for physicians and a series of webinars about chronic care management.