What Payment Amount Should I Expect?

Payment in 2015 under the Medicare PFS for CPT code 99490 is about $42* per calendar month, and standard coinsurance and deductibles apply. Patients are subject to a copay of approximately $8 or 20 percent each time you bill the service.

You must explain how cost-sharing applies to CCM services during the patient agreement and consent process. CMS states “although patient cost-sharing applies to the CCM service, CCM may help avoid the need for more costly face-to-face services in the future by proactively managing patient health, rather than only treating disease and illness.”

The monthly and annual payment amount will vary depending on the quantity of your eligible Medicare patients who consent to participation, their need for CCM services, and billing frequency.

Payment assumption: 

150 patients with two or more chronic conditions X $42* per calendar month X 12 months = $75,600 

Because care management is an integral part of the services below, the following codes** cannot be billed during the same month as CPT code 99490:  

Transitional Care Management (CPT 99495 and 99496)

Home Healthcare Supervision (HCPCS G0181)

Hospice Care Supervision (HCPCS G0182)

Certain ESRD services (CPT 90951-90970)

*Average, subject to regional variation. See the Medicare physician fee schedule search tool.

**With the exception of a few ESRD services, the payment amount for these services is higher than for CPT code 99490.

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Last Updated On

May 13, 2016