Chronic Care Management Overview:

The Centers for Medicare and Medicaid (CMS) created the original CPT code 99490 to pay providers for delivering non-face-to-face care to Medicare patients with two or more chronic conditions. Physician practices can bill CMS directly for these services, and can outsource these services to third-party providers if they choose. By providing CCM services, you can help patients stay healthier and avoid unnecessary hospitalizations while generating significant recurring revenue streams.

The Opportunity:

The original CPT Code 99490 allows eligible practitioners and suppliers to bill $42 for at least 20 minutes of non-face-to-face clinical staff time each month to coordinate care for patients with two or more chronic conditions.

In addition to CPT code 99490, in 2017 CMS updated the Medicare CCM program and introduced three new billing codes. These three codes offer providers with further financial reimbursement opportunities for providing chronic care management services.

HCPCS code G0506 is a one-time code that providers can now bill in addition to the CCM initiating visit. This code reimburses providers $63 for an extensive assessment and CCM care planning beyond the usual effort.
CPT code 99487 is for complex CCM, requiring substantial revision of a care plan and medical decision making of moderate to high complexity. Providers are reimbursed $93 for 60 minutes of clinical staff time.
CPT code 99489 is an add on code to CPT code 99487 that provides $47 of reimbursement for each additional 30 minutes of clinical staff time.

Ongoing Annual Wellness Visits (AWVs) can be provided once a year to focus on maintaining the beneficiary's overall health and managing their chronic conditions. HCPCS code G0439 requires a higher level of patient engagement through the creation of personalized prevention plans and rising risk identification of patients.

HCPCS Code G0439 reimburses physicians $118 per patient for following the criteria of administering a health risk assessment, measuring the beneficiary's vital signs, and furnishing personalized health advice. And while Annual Wellness Visits are paid at 100%, it is estimated that only 12% of Medicare beneficiaries receive this service on a yearly basis.