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CPT Code 99490 | Chronic Care Management Services

CPT code 99490 refers to chronic care management services provided to patients with multiple chronic conditions that are expected to last at least a year or until the patient’s death and which may pose a significant risk of death, acute exacerbation, or functional decline.

What Is CPT Code 99490?

CPT 99490 refers to chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year or until the patient’s death.

These conditions may pose a significant risk of death, acute exacerbation, or functional decline.

Chronic care management services involve the establishment, implementation, review, and monitoring of a comprehensive care plan under the direction of a physician or other qualified healthcare professional.

These services may include communication with the patient, caretakers, and other professionals about care; data collection; assessment and support for self-management, including medication management; identification and assistance with access to relevant community and health resources; management of care transitions; review of patient status; and development, communication, and maintenance of the care plan.

This code should be used for the first 20 minutes of clinical staff time per calendar month related to chronic care management services and directed by a physician or other qualified healthcare professional.

Description

The CPT book describes CPT code 99490 as: “Chronic care management services 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,
  • comprehensive care plan established, implemented, revised, or monitored;

First 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.”

Procedure

Clinical staff, under the direction of a physician or other qualified healthcare professional, provides chronic care management services for a patient with two or more chronic conditions, such as congestive heart failure and diabetes.

Clinical staff members play an important role in areas such as communicating with the patient, caretakers, and other professionals about care; collecting data; assessing and supporting self–management, including medication management; identifying and helping with access to relevant community and health resources; managing care transitions; reviewing patient status; and developing, communicating, and maintaining the care plan.

The physician or other qualified healthcare professional directs the clinical staff. Use this code for the first 20 minutes in a calendar month of clinical staff time related to chronic care management services.

How To Use CPT 99490

For each additional 20 minutes, see add-on code CPT 99439.

The total duration of the staff care management services must meet the time listed in the code descriptor to be reported.

Resources

CPT Professional 2022

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