CPT 99490

CPT Code 99490 (2021)

The section title of “Complex Chronic Care Coordination” has been changed to “Care Management Services” with an addition of a new subsection, “Chronic Care Management Services” to better reflect the management services described by new code CPT 99490.

The new code requires chronic care management services that take at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:

  • multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
  • chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, and
  • comprehensive care plan established, implemented, revised, or monitored.

Medicare has announced that it will reimburse for 99490 instead of the initially-proposed G-code, and the Work Relative Value Unit (wRVU) is 0.61.

Please note that chronic care management services of less than 20 minutes in a calendar month are not reported separately. The 20 minutes is in contrast to at least 60 minutes of complex chronic care management service that would be reported by a code CPT 99487.  

Also, the add-on code CPT 99489 should not be reported for service of less than 30 minutes in addition to the first 60 minutes of complex chronic care management services during a calendar month.  

According to the American Medical Association, in addition to the above criteria for care management services, the requirements for complex care management services include:

  • establishment or substantial revision of a comprehensive care plan,
  • moderate or high complexity of medical decision-making, and
  • 60 minutes of clinical staff time directed by a physician or QHCP per calendar month.

Patients may be identified by practice-specific or other published algorithms that recognize:

  • multiple illnesses,
  • multiple medication use (and potential for drug interactions),
  • inability to perform activities of daily living,
  • requirement for a caregiver, and/or
  • repeat admissions or Emergency Department (ED) visits.  

Reference: http://medicaleconomics.modernmedicine.com

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