Chronic Care Management

Medicare covers chronic care management services if a patient has two or more serious conditions that are expected to last at least a year. Medical offices often question the correct way to code for CCM for Medicare. CodingIntel provides the correct way to utilize CPT^® 99490, 99487 and 99489.

 

Use of CPT^® codes 99490, 99487, 99489, 90491 and HCPCS codes G0506, G2058

99487 – Complex chronic care management services, 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,
• Establishment or substantial revision of a comprehensive care plan,
• Moderate or high complexity medical decision making;
• 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

+ 99489– each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

99490– 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.

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