The Medicare reimbursement for CPT codes 99487, 99489, 99490, 99491, and G2058 can be claimed by care providers who offer chronic care management to their patients suffering from two or more chronic conditions. The care provided under CCM with advanced consent includes:
- Continuity of Care with Designated Care Team Member
- Comprehensive Care Management and Care Planning
- Coordination with Home and Community-Based Clinical Service Providers
- 24/7 Access to Address Urgent Needs
- Enhanced Communication (ex. email, app notifications)
This code can be used by qualified medical professionals who offer non face-to-face chronic care management for at least 60 minutes per consultation. Medical practitioners can charge roughly $92 per session and this code can be claimed once a month for each patient. The 60 minutes scheduled should cover ongoing oversight, direction, and management of care plans.
This code allows medical care to bill up to $45 for every additional 30 minutes of non face-to-face consultation provided to the chronic patient. It must be used along with CPT 99487 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.
This code involves at least 20 minutes of non face-to-face consultation that can be used to monitor the vitals, check the compliance to care plan, and assess the effectiveness of the ongoing care treatment. The USA average reimbursement rate for CPT 99490 is $42 per consultation per patient. Each patient may be billed under CPT 99490 once per month.
This code can only be used by a physician or other qualified healthcare professional rather than any clinical staff. It charges about $84 per consultation and can be billed once a month. This code was introduced in January 2019 for consultations that exceed 30 minutes. The billing is roughly double that of CPT 99490 as it involves twice the allocated time (30 minutes vs 15 minutes). CPT 99491 and CPT99490 cannot be billed in the same calendar month.
This code was introduced in January 2020 for every additional 20 minutes of nonface to face consultation. The care involves non-complex CCM and can be directed by either clinical staff or physicians/other qualified professionals. This code must be used in tandem with CPT99490 for any care that is 41-60 minutes in length. It is not necessary to use this code for sessions that are 21-40 minutes in length. As this code is being paired with CPT99490, it cannot be paired with any other CPT codes during the same calendar month.
The following table lists the 2020 Chronic Care Management reimbursement rates for CPT 99490 across various states or regions in the US.
|REGION||CPT 99490 REIMBURSEMENT ESTIMATES 2020|
|California, Alameda/ Contra Costa County||$49.03|
|California, Los Angeles County||$46.07|
|California, Marin County||$48.40|
|California, Napa County||$46.88|
|California, Orange County||$46.07|
|California, San Francisco City||$49.03|
|California, San Mateo County||$49.03|
|California, Santa Clara County||$50.04|
|California Ventura County||$45.61|
|Rest of California||$43.29|
|DC + MD / VA Suburbs||$47.97|
|Florida Fort Lauderdale||$43.62|
|Rest of Florida||$41.59|
|Rest of Georgia||$39.82|
|Illinois, East St Louis||$42.23|
|Illinois, Suburban Chicago||$44.47|
|Rest of Illinois||$40.71|
|Louisiana, New Orleans||$41.68|
|Rest of Louisiana||$39.99|
|Maine, Southern Maine||$41.55|
|Rest of Maine||$39.53|
|Maryland, Baltimore / Surr. Cntys||$45.14|
|Rest of Maryland||$43.24|
|Massachusetts, Metropolitan Boston||$46.62|
|Rest of Massachusetts||$43.83|
|Rest of Michigan||$40.33|
|Missouri, Metropolitan Kansas City||$41.21|
|Missouri, Metropolitan St Louis||$41.43|
|Rest of Missouri||$38.89|
|New Jersey, Northern New Jersey||$46.71|
|Rest of New Jersey||$45.27|
|New York, Manhattan||$48.52|
|New York, NYC Suburbs / Long Island||$49.79|
|New York, Poughkeepsie/ NYC Suburbs||$45.22|
|New York, Queens||$49.96|
|Rest of New York||$40.63|
|Rest of Oregon||$40.63|
|Pennsylvania, Metropolitan Philadelphia||$44.72|
|Rest of Pennsylvania||$40.84|
|Texas, Fort Worth||$41.64|
|Rest of Texas||$40.58|
|Washington, Seattle ( King County)||$45.86|
|Rest of Washington||$42.14|
The tabular data is for estimation only. It is not a legally bound guarantee of results. Please check for revised rates in your area. HealthViewX is not liable for the accuracy of this content. The data is for calculation estimation only.
1) CMS.gov – County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average.
2) Reimbursement amount from the CY 2015 Physician Fee Service Final Rule, October 31, 2014, averaged across 89 localities.