The Centers for Medicare and Medicaid (CMS) began in 2022 to promote the growth1 of remote chronic care management (CCM). Medical practices are seeing the benefit of adding CCM to their RPM program, and RPM to the CCM programs.
To add remote CCM for your patients, it is important to understand the CPT© codes to insure correct reimbursements from Medicare and Medicaid. A highly functional CCM portal will help with correct billing.
Below is a quick synopsis of relevant CPT© codes2 that are to be used for CCM. We will begin with the two main codes that will be used, CPT© 99490 and CPT© 99491.
CPT© 99490 – First the patient must meet the requirements of having two or more chronic conditions that will persist for a minimum of 12 months. The patient is at significant risk of functional decline, decompensation and/or death.
This code covers chronic care services lasting at least 20 minutes which must be rendered by clinical staff who are directed by a physician, per calendar month.
A comprehensive care plan must have been established, implemented, adapted, and monitored (remotely or in-person). The 2023 reimbursement rate is $61.16.
CPT© 99491 – This is for chronic care services provided by a physician directly, that are at least 30 minutes in length, per calendar month.
All the requirements of CPT© 99490 are applicable for this code, as well. The 2023 reimbursement rate is $82.98.
The major difference between 99490 and 99491, is that 99490 can have the services performed by a clinical staff under the direction of a physician, while 99491 is services performed directly by a physician.
An additional difference is that 99490 only requires a 20-minute threshold, whereas 99491 has a 30-minute threshold. The reimbursement amount is different, as well.
CPT© 99439 is for chronic care management services of each additional 20 minutes which are rendered by clinical staff who are directed by a physician, per calendar month. The 2023 reimbursement rate is $46.28.
This code cannot be reported more than twice per calendar month, and only in conjunction with CPT© 99490 for the initial 20-minute time allotment.
Likewise, CPT© 99437 is for chronic care management services of each additional 20 minutes which are rendered directly by a physician, per calendar month. The 2023 reimbursement rate is $58.52.
This code cannot be reported more than twice per calendar month, and only in conjunction with CPT© 99491 for the initial 30-minute time allotment.
The next CPT© codes are for complex CCM. The major difference between non-complex and complex CCM is the moderate or high-complexity medical decision making needed for complex CCM.
CPT© 99487 is used when the criteria for CCM occurs and services are provided by a clinical staff under the direction of a physician within a calendar month. The billing is for a minimum of 60 minutes. The 2023 reimbursement rate is $129.93.
CPT© 99489 is an add-on for CPT 99487. It is used in conjunction with 99487, for additional 30-minute segments of CCM provided by clinical staff under the direction of a physician within a calendar month. The 2023 reimbursement rate of $68.77.
Many practices have RPM programs where they are monitoring the blood pressure, glucose levels, and/or blood ox of their patients. When those patients have two or more of these chronic conditions for more than 12 months, then expanding their care into CCM will be better for your patients and your practice.
Having knowledge of these CPT© codes and how they can apply to your chronic care patients can expand your practice. A user-friendly, and accurate CCM Portal can help assure that your billing and CPT© codes are correct.
Medek RPM, a leading RPM company in the U.S., has developed a user-friendly, effective portal for CCM. Medek can show you the benefits of combining RPM and CCM programs within one portal.
Start a conversation with a Medek Representative to see how you can add a new CCM portal to your RPM program, to help grow and expand your medical practice.