Chronic care management executed remotely is a win-win for both patients and care providers. The Medicare CPT codes for chronic care management encourage care providers to offer remote healthcare to chronic patients. Across America care providers are growing their practice through the additional revenue channel of CCM Medicare CPT codes reimbursement. In all cases, documentation of consent should be maintained
How do patients benefit from Chronic Care Management?
Patients with two or more chronic medical conditions can benefit from the CCM services. Chronic diseases are defined as those conditions expected to last a minimum of 12 months after diagnosis and put the patient at a risk of death or functional decline.
Such patients above the age of 65 can stay connected through telephone, web or mobile applications with their care providers for regular monitoring and in case of emergencies. Such coordinated care improves their wellbeing and reduces the cost incurred in face-face treatment if it is substituted by remote care.
How can medical professionals benefit from Chronic Care Management CPT Codes 99490 and 99487 and 99489?
Physicians and Non-Physicians can benefit from Medicare’s reimbursement for chronic care services.
Non Physicians include Certified Nurse-Midwife, Physician Assistant, Nurse Practitioner and Clinical Nurse Specialists. The flexibility of remote medical monitoring offers patients and professionals convenience to reach out as per their schedule.
|CPT Code||CPT Amount(approx) per consultation||Description|
|CPT99490||$42||Min 20min nonface to face time monitoring the care plan|
|CPT99487||$60||Min 60min nonface to face consultation time establishing or monitoring a care plan|
|CPT99489||$47||To be billed with CPT 99487 for every additional 30 min of nonface to face consultation|
By using this code, care providers can bill approximately $42 per consultation. This includes at least 20 minutes of nonface to face consultation that can be used to monitor the vitals, check the compliance to care plan and effectiveness of the ongoing care treatment. This time can also be used to establish a new care plan based on the patient’s condition. Care providers must keep in mind that only one medical professional can bill using this code per month per patient. To claim the reimbursement for care provided to the patient, the claim must be submitted once a month by the professional who provided care in that month. Medical practitioners should also use a recognized Electronic Medical Record System to securely access the patient records remotely.
Using this code, medical professionals may bill approximately $94 per consultation. This code may be used by medical professionals who offer chronic care management for at least 60 minutes per consultation. This refers to nonface to face consultation. In cases where 20 minutes of care may not be sufficient and additional detailed monitoring is required, CPT 99487 code may be used. Treatment, in this case, includes advanced medical care planning and monitoring. A recognized electronic record system ensures smooth care transition between primary care providers and specialists. The 60 minutes scheduled should cover ongoing oversight, direction, and management of care plans. Decision making of moderate-high complexity may be needed. This code can be used by only one medical professional per patient per billing cycle. The claim for CPT reimbursement can be submitted once a month.
This code has to be used along with CPT 99487. With this code, medical care providers can bill up to $47 for every additional 30 minutes of consultation provided to the chronic patient. This additional time may be used to establish a care plan or substantially revise an existing plan. A care plan should include a complete assessment of patient needs taking into account the physical, functional, psychological and environmental conditions of the patient.
Challenges in implementing chronic care management for Medicare reimbursement:
Care providers have always had put in a lot of workloads doing back-end nonface-to-face tasks to manage patients. This includes time to schedule appointments, follow-ups to ensure that the patient is complying with the care plan prescribed, calls to collect vital patient information at regular intervals etc.
The Medicare CPT codes CPT 99490, CPT 99489 and CPT 99487 help practitioners monetize these previously unbilled tasks. The chronic care management CPT codes allow for billing up to $42 for 20-minute nonface-to-face care time with the patients. While this may be a good additional stream of revenue to practitioners, it comes with its own implementation challenges.
- The technical preparedness of the practice: Medicare CCM codes can only be billed by hospitals which have a certified electronic medical record ( EMR / EHR) system integrated into their practice. Such a financial commitment is not always affordable, especially for smaller practices. In 2017, changes have been proposed to remove the clause which mandates requirement of EHR systems for Medicare billing.
- Patient Consent: Before billing for Medicare CPT codes, providers must obtain patient consent. Since there are no readily available templates of the consent form, each practice must spend time in creating templates that can be used based on the patient profiles they treat. The consent forms must also be stored for future reference. Obtaining patient consent before each appointment can be time-consuming. In 2017, it has been recommended to do away with mandatory the consent procedure.
- Staffing needs and Billing time: Since the CCM services can be billed only at the end of each month, records such as the discussion details, conversation/email summary, care plans etc. must be maintained of each patient serviced through CCM. Additional staff may be needed to manage the patient consent, bill submission, and accounting procedures. This adds to the overheads of the practice.
- Patient payments: Medicare does not bear 100% of the charges for consultation through CCM. Patients have to pay 20% ( about $ 8 per consultation) of the charges. This makes patients reluctant to sign the consent form for CCM. Quick nonface-to-face follow-ups on care compliance were being provided by practitioners as a part of extended patient service and optimal care quality even before the CCM CPT codes came into effect. Some patients expect this to continue and perceive billing for CCM as the provider’s greed for money.
To overcome these challenges, it is important to educate patients on the advantages of CCM and help them see the long-term value of providing consent for CCM services. The proposed changes to the mandatory consent and mandatory EHR requirement will also help more practitioners adopt CCM CPT codes.