Don't Miss Out! Medicare Pays for Chronic Care Management

Do you manage patient referrals and care transitions between and among physicians and health care settings? Do you spend time reconciling medication lists and managing prescription refills for your patients? Do you take calls during and after office hours to address patient care needs? If the answer is yes and you're not billing for these types of services, you're missing out on a new CPT code and practice revenue opportunity from Medicare.   

In January, Medicare began paying separately for chronic care management (CCM) services under the Medicare Physician Fee Schedule (PFS). CCM services are non-face-to-face activities performed by you or your clinical staff to manage and coordinate the care of your patients. You've long provided these services at your own expense. But now, Medicare will pay you for your time on a monthly basis. 

Under the Medicare PFS, CCM services are billable using CPT code 99490 for your patients with two or more chronic conditions. Before billing, you must comply with multiple requirements, including patient consent and the use of certified electronic health record technology. Payment is approximately $42 for a minimum of 20 minutes of qualifying care per patient per calendar month. 

The health care industry is reporting a potential annual revenue as high as $75,000 to $100,000 or more per physician. TMA says the total payment physicians will receive depends on the quantity of eligible Medicare patients who consent to participation, their need for CCM services, and billing frequency.  

To help you determine whether this new opportunity is right for your practice, TMA created a new resource center outlining all the details. Read about Texas physicians who have implemented CCM services in their practices in the September 2015 issue of Texas Medicine.   

Action, Sept. 1, 2015

Last Updated On

November 22, 2019

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