Payment of Chronic Care Management Services Under CY 2015 Medicare PFS

In Calendar Year (CY) 2015, CMS will begin making separate payment under the Medicare Physician Fee Schedule (PFS) for chronic care management (CCM) services under Current Procedure Terminology (CPT) code 99490. CCM services are non-face-to-face care management/coordination services for certain Medicare beneficiaries having multiple (two or more) chronic conditions. During this MLN Connects™ National Provider Call, subject matter experts review the requirements for physicians and other practitioners to bill the new CPT code to the PFS.

Beginning Jan. 1, 2015 Medicare will pay for Chronic Care Management (CCM) services, CPT® code 99490 under Part B fee for service. The CPT® definition is:

 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.

 Per CPT® 99490 billing requirements include:
• Identifying patients with multiple chronic care conditions
• Managing the patient agreements and care plans
• Tracking care time to insure appropriate billing
 CMS has made some parts of the program clear, such as the CPT code and amount of reimbursement (CPT code 99490 for $42.60 per patient per 30-day period), amount of time required to bill (a minimum of 20 minutes), and left other requirements open to interpretation -

The agreement that providers must provide to their patients is required to explain:
• That only one practitioner can furnish and be paid for these services
• That the patient can terminate the agreement at any time
• That Medicare co-insurance payments apply
• The types of Chronic Care Management Services that your practice provides

In addition, you will want to explain what terms the patient is agreeing to by signing, as required by Medicare, including:

Consenting to the Provider providing CCM services.
1. Acknowledging that only one practitioner can furnish CCM Services to the patient during a thirty (30)-day period.
2. Authorizing electronic communication of the patient’s medical information with other treating providers to facilitate the coordination of care.
3. Acknowledging that the Medicare Co-Insurance amount applies to CCM Services.
4. Recognizing that the patient has the right to stop CCM Services at any time by revoking the Agreement by notifying the practice via a specified method.

Providers eligible to bill Medicare for chronic care management include:
• Physicians (regardless of specialty),
• Advanced practice registered nurses,
• Physician assistants,
• Clinical nurse specialists, and
• Certified nurse midwives (or the provider to which such individual has reassigned his/her billing rights)

Other non-physician practitioners and limited-license practitioners (e.g., clinical psychologists, social workers) are not eligible.

Note:Chronic care management  services of less than 20 minutes duration ,in a calendar month ,are not reported separately.