As the aging process occurs in the U.S. population, a significant number of individuals are grappling with enduring ailments. To be specific, approximately 80% of elderly individuals face chronic health issues, and out of these, 77% manage two or more such conditions, as per reports provided by the National Council of Aging.
For these vast numbers of people, the management of chronic conditions plays a pivotal role in enhancing their health and overall quality of life. This enables them to lead active, self-reliant lives. CPT codes are utilized to keep track of procedures and services connected to the care of chronic conditions.
Medicare formulated CCM with the intention of enabling doctors and healthcare groups to administer consistent medical care to patients in the intervals between regular appointments, carried out through remote interactions. Characterized as a monthly initiative, Medicare requires a minimum of 20 minutes dedicated to patient service every month for CCM reimbursement to be applicable.
To meet the criteria for CCM eligibility, a patient must be diagnosed with two or more chronic conditions anticipated to persist for at least 12 months. Additionally, the patient’s medical practitioner must document any persistent health issues within the 12 months leading up to CCM enrollment. These chronic ailments must entail a notable risk of mortality, sudden deterioration, or reduced functional capability.
CCM services encompass:
Ensuring a grasp of Chronic Care Management (CCM) CPT codes enables your organization to secure timely Medicare reimbursements and effectively organize patient care. These advantages result in departmental cost reductions—ultimately safeguarding your financial foundation and revenue cycle.
To maximize your Medicare reimbursements, provided here is a compilation of pertinent CCM CPT codes, their explanations, and the corresponding expenses for your remote patient monitoring (RPM) initiative.
| Code | Description | Reimbursement |
| 99437 | An additional half-hour of care is given directly by a doctor or NPP. | $59.98 |
| 99439 | Following that, an additional 20-minute period of care was delivered by the medical personnel. | $47.44 |
| 99487 | A total of at least 60 minutes spread out over a span of 30 days, involving remote discussions for devising or overseeing a care strategy. | $133.18 |
| 99489 | For each extra half-hour of remote discussion, use CPT 99487 for invoicing purposes. | $70.49 |
| 99490 | A total of at least 20 minutes spread out over a span of 30 days, involving remote time dedicated to overseeing the care plan. | $62.69 |
| 99491 | First half-hour of care directly administered by a doctor or non-physician practitioner (NPP). | $85.06 |
CPT 99437 functions as an added code to complement CPT 99491, offering additional time beyond the initial 30-minute care covered by 99491.
CPT 99437 shares the same eligibility criteria and requisites as CPT 99490, 99439, and 99491. Similar to CPT 99491, all care must be personally provided by a doctor, NP, or other qualified healthcare professional to be eligible for reimbursement under CPT 99437.
In conjunction with CPT 99490, CPT 99439 can be employed on a monthly basis for an additional half-hour of care offered for non-complex CCM administered by clinical staff under a doctor’s supervision.
Introduced in 2017, CPT 99487 was created to address the coordination of care for particularly intricate patients. Through this code, Medicare provides reimbursement for the initial 60 minutes of non-face-to-face care coordination conducted by the clinical staff.
Distinguishing CPT 99487 from CPT 99490, which was introduced in 2015, involves the extended 60 minutes of physician care time eligible for reimbursement, along with the prerequisite of moderate or high complexity medical decision-making concerning patients.
Additional prerequisites and patient services that fulfill the criteria for CPT 99487 reimbursement comprise:
As an extension to CPT 99487, CPT 99489 can be appended to account for extra time dedicated to care coordination services each month. While CPT 99487 covers reimbursement for the initial 60 minutes of non-face-to-face consultation, CPT 99489 provides reimbursement for every additional 30-minute segment of a session.
Introduced in 2017, this code acknowledges that intricate chronic care management patients often necessitate multiple hours of non-face-to-face care coordination on a monthly basis.
With CPT 99490, Medicare offers reimbursement for non-face-to-face monitoring and non-complex CCM carried out by the clinical staff under a doctor’s supervision. This code emphasizes reimbursing services for patients dealing with two or more chronic conditions, aiming to prevent the exacerbation or deterioration of these ailments.
The criteria to qualify for CPT 99490 are identical to those for CPT 99487, except for a lower minimum duration of 20 minutes for the provided care.
Added in 2019, CPT 99491 was introduced to provide reimbursement for at least 30 minutes of direct care offered by physicians and nurse practitioners. This code serves as an extension to code 99490, sharing similar patient qualification criteria: the presence of two or more chronic conditions, a notable risk of death, acute exacerbation, or functional decline, as well as the establishment of a comprehensive care plan.
The distinguishing factors between the two codes are as follows:
Various health conditions meet the criteria for chronic care management (CCM). Among these are the foremost five chronic ailments that significantly impact overall population health:
For both 2020 and 2021, the 99490 CPT code registered the highest overall number of procedures: 1,911,937 procedures in 2020 and 1,667,559 procedures in 2021. This code oversees chronic care management services for the initial 20-minute duration of clinical staff time each month.
The total procedures for the leading 9 CPT codes stood at 256,778 in 2020 and 254,195 in 2021. Throughout both years, the mean total procedures for the top 9 CPT codes equated to 255,486.
These trends highlight a prevalence of 20-minute clinical interventions in CCM. Interestingly, the CPT code ranking third is associated with behavioral health services, aligning with the increased utilization of mental health services seen in 2021. Healthcare providers can utilize this data to make well-informed decisions regarding their treatments and services.
With a clinician’s outlook, 360HealthTek crafted a user-friendly approach that streamlines the entire Chronic Care Management (CCM) process. This empowers you and your patients to make the most of its advantages. Our care coordination solution for CCM enables you to provide a comprehensive array of wellness services that complement the CCM process seamlessly.
Provider of state-of-the-art healthcare technology solutions for patients, payers, and providers.
CONTACT US
