The Centers for Medicare & Medicaid Services (CMS) recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending.
Beginning January 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology
(CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. CPT 99490 is defined as follows:
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional,
per calendar month, with the following required elements:
` Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
` Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
` Comprehensive care plan established, implemented, revised, or monitored
This fact sheet provides background on the newly payable chronic care management (CCM) service, identifies eligible providers and patients, and details the Medicare PFS billing requirements.
Examples of chronic conditions include, but are not limited to, the following:
` Alzheimer’s disease and related dementia;
` Arthritis (osteoarthritis and rheumatoid);
` Atrial fibrillation;
` Autism spectrum disorders;
` Chronic Obstructive Pulmonary Disease;
` Heart failure;
` Ischemic heart
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