Who Can Furnish and Bill for CCM Services?

Physician and Practitioner Eligibility

On January 1, 2015, Medicare began paying separately for chronic care management services under the Medicare PFS. The requirement for billing is a minimum of 20 minutes of qualifying care per patient per calendar month. Check with your other payers to see if they, too, provide payment for CCM services.

Physicians, physician assistants, nurse practitioners, certified nurse midwives, and clinical nurse specialists may furnish and bill for services under the Medicare PFS. Clinical staff also may furnish CCM services under the general supervision of the billing physician or other eligible practitioner. CCM services are typically provided by primary care physicians, but specialists may bill, too, if all requirements are met. However, only one physician or other eligible practitioner may receive payment per patient per calendar month.

The billing code is CPT code 99490 and it 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 or decompensation, or functional decline; and
  • Comprehensive care plan established, implemented, revised, or monitored.  

Chronic Care Management main page

 

Last Updated On

April 19, 2017