The remote execution of Chronic care management 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.  

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, 99491, 99487,G2058 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 99490:

By using this code, care providers can bill approximately $42 per consultation. This includes 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 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 patient every month. 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 (EMR) System to securely access the patient records remotely.

G2058:

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. 

CPT 99491:

This code was introduced in January 2019 and care providers may bill $84 per consultation. The code has a few significant differences from the similarly named CPT 99490. 99491 must involve a physician or other qualified healthcare professional rather than any clinical staff. Also this new code is specifically for consultations that exceed 30 minutes. These two codes cannot both be used in the same calendar month and a CPT 99491 can only be issued once in a month. The billing is roughly double that of CPT 99490 as it involves twice the allocated time (30 minutes vs 15 minutes).

CPT 99487:

Using this code, medical professionals may bill approximately $92 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 non face-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. In this case, treatment 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.

CPT 99489:

This code has to be used along with CPT 99487. With this code, medical care providers can bill up to $45 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 to put in a lot of workloads doing back-end non face-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, or calls to collect vital patient information at regular intervals.

The Medicare CPT codes CPT 99487, CPT 99489, CPT 99490, CPT G2058 and CPT 99491help practitioners monetize these previously unbilled tasks. The chronic care management CPT codes allow for billing up to $42 for 20-minute non face-to-face care time with the patients. While this provides practitioners with an additional stream of revenue, it comes with its own implementation challenges.

1. 1. 1. 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 large financial commitment is not always affordable, especially for smaller practices. In 2017, changes were proposed to remove the clause which mandates the requirement of EHR systems for Medicare billing.
      2. 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 phase out the mandatory consent procedure.
      3. 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, and care plans must be maintained for 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.
      4. 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 non face-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.

Reference: https://www.hccinstitute.org/app/uploads/2020/02/What-You-Should…-2020-Coding-Updates_HCCI.pdf