Effective January 2019, a new code was added to the CCM group of codes reimbursing physicians and clinical staff for non-face to face care to qualifying Medicare patients: CPT CCM code 99491.
What does CPT CCM code 99491 cover?
This code is very similar to the original CCM code 99490 that was introduced in 2015. It requires the same patient eligibility including two or more chronic conditions that place the patient at significant risk of death, acute exacerbation or functional decline and where a comprehensive care plan was established and to be implemented, revised and monitored by the billing practitioner for such patient. Chronic care management services are then to be provided by the physician or qualified healthcare professional personally. This code requires 30 minutes of CCM care a month and pays $74.26
How does CPT CCM code 99491 differ from CPT code 99490?
CPT code 99490, effective since January 2015, requires a minimum of 20 minutes a month of CCM care and pays on average $43 a month. Under CPT 99490, clinical staff supervised by a doctor can perform CCM for billing purposes. The new code 99491 compensates doctors and nurse practitioners for their time spent on CCM related care and requires them to provide such care personally. It also requires a minimum of 30 minutes a month.
How should providers use this new CPT CCM code 99491?
We expect that CCM providers are most likely to use this code with their high risk patients. Especially where direct care by a doctor or nurse practitioner is appropriate, whilst also continuing to provide CCM care by their clinical staff such as registered nurses and medical assistants for lower risk patients and utilize CPT code 99490. Codes 99490 and 99491 cannot be billed in the same month for the same patient so practices will need to decide if this new code is a good use of their doctors’ time and which patients would benefit from it.
What codes can be billed together with CPT CCM code 99491?
Remote monitoring codes including CPT code 99091, 99453, 99454 and 99457 can be billed in the same month together with the code 99491 because remote monitoring services are complementary to CCM care. Other CCM codes such 99490 or complex CCM codes 99487 and 99489 cannot be billed in the same month. All conditions must be met for each individual code and time cannot be double counted to qualify for reimbursement under each code.
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