Decoding CPT Codes for Chronic Care Management: A Guide for Healthcare Providers

Managing chronic conditions is not just about direct patient care but also about providing comprehensive support that extends beyond traditional office visits. Chronic Care Management (CCM) is a Medicare program that compensates care navigators for providing non-face-to-face services to its beneficiaries with multiple chronic conditions. The time spent doing care management is measured in increments of 20, 40, and 60 minutes and corresponds directly to CPT codes which can be billed for their respective reimbursement.

The goals of CCM are aligned with the core of value-based care: improve patient outcomes and reduce cost. As our population ages and lives longer with chronic illnesses, coordinated delivery of care and a multi-disciplinary approach to care management through CCM will position physician practices to become a high touch point system that can capture the patients who would otherwise end up in the Emergency Departments or worse admitted. 

Medicare’s interest in ensuring the proliferation of CCM programs across practices is evidenced by its increasing investment into the program: reimbursements for all codes discussed below have gone up by at least 30% since its launch in 2014, with reports of further increases in the pipeline… The baby-boomer generation is set to account for the largest part of our collective population during the next decade. Additionally, Medicare’s deadline of 2030 for the implementation of value-based care across all physician practices is a buttress to its intent of emboldening its quest to improve patient outcomes. 

Value-based care is the future of modern medicine. CCM is the vehicle for accomplishing its goals.

Gen By Gen Health’s turn-key CCM solutions manage care prescribed by physicians, reduce staff’s administrative workload, and foster high-touch patient engagement resulting in increased revenue and improved quality metrics.

Understanding Key CPT Codes for Chronic Care Management

1. CPT Code 99490

Description: The most commonly used CPT code and often the performance benchmark for the effectiveness of a CCM service provider,  involves providing and accurately documenting 20 minutes of care management time spent by a care coordinator under the supervision of a qualified healthcare professional per calendar month. The following are considered billable services that fulfill the requirement for a reimbursement of approximately $63 :

  •    Development, revision, or monitoring of a comprehensive care plan.
  •    Communication with other treating health professionals.
  •    Integration of updated information into the care plan.
  •    Patient education and self-management support.

CPT Code 99439

Description: Add-on code for 99490, that reimburses $47 for each additional 20 minutes of clinical staff time spent per calendar month.

2.  CPT Code 99487

Description: Often referred to as Complex CCM, one of the newer codes introduced by Medicare in 2017 to accommodate 60 mins of time spent per calendar month managing care involving moderate- to high-complexity medical decision-making for reimbursement of $133.

CPT Code 99489

Description: Add-on code for 99487, which reimburses $70 for each additional 30 minutes of clinical staff time spent per calendar month.

Documentation

Below are elements of documentation needed to record work done, justify time billed, and serve as evidence in the event of a Medicare audit. These factors, although not comprehensive, set up a framework within which care management services are performed.

1. Patient Consent

Obtain and document patient consent for CCM services, including an explanation of services, patient responsibilities, and any potential costs.

2. Comprehensive Care Plan:

Develop, revise, or monitor a comprehensive care plan for each patient that includes:

    • Problems and conditions addressed.
    • Expected outcomes and actions.
    • Medications and treatments.
    • Advance care planning, as appropriate.

3. Care Coordination:

  • Document coordination efforts with other healthcare providers and services involved in the patient’s care.
  • Maintain communication logs or summaries of consultations and referrals.

4. Patient/Family Engagement and Education:

  • Document patient education efforts, including self-management support provided.
  • Note any discussions on adherence to treatment plans and lifestyle modifications.
  • Record communication when engaged with the patient’s family

A robust software that allows ease of documentation of work done is crucial for workflow efficiency. ChronicCareIQ is Gen By Gen’s trusted partner in Care Management. It allows for detailed accounting for care plans and patient adherence while upholding the highest level of HIPAA compliance.

Billing

Document the total time spent on CCM activities per patient per month with specifications to the complexity of medical decision-making and care coordination efforts.

ChronicCare IQ automates time tracking to the last second. It has enabled smart technology within the program to track our nurses’ activities with precision as fine as recording the part of the patient’s chart where most time is spent. CCM CPT codes are unique wherein reimbursements rely on time spent versus an acknowledgment of service provided; as is seen with other CPT and E&M codes. The detailed level of time and activity tracking provided by CCIQ gives Gen By Gen Health peace of mind and its clients’ authentication of the work being done on behalf of our mutual patients.

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