How to Meet CPT Code 99490 Requirements for Chronic Care Management & Get Reimbursed by Medicare?

Medicare providers, beneficiaries and all other stakeholders in the healthcare sector have got a big stimulus from CPT 99490 which began on 1st January this year. The main stimulus is the provision for getting reimbursed for medical services that healthcare service providers including physicians and support staff are already providing people for years. This new regulation is destined to give a positive boost to the support and care provided by health care providers and physicians. Moreover, patient care after this regulation became transformed to a great extent. Now, in the present context, it not only requires continuous engagement with patients but also incorporation of an array of technologies. Center for Medicare part D plans and Medicaid Services (CMS) estimated that CPT 99490 will play a pivotal role in increasing revenue for medical services and the estimated increase is supposed to be somewhere around $250,000 per year.

Qualification criteria for Medicare reimbursement in the present context

From the beginning of current year the Centers for Medicare & Medicaid Services (CMS) began to reimburse healthcare services for chronic care management (CCM). As per the new regulation, the benefit of this reimbursement policy will be provided to patients who at least have two chronic conditions lasting for more than a year.

Though the rate of reimbursement differs from one state to another because of the differences in Medicare fees, at present CMS offers a reimbursement at a rate of approximately $40 per Medicare beneficiary. Another aspect which is important in the new context of Medicare services is the mandatory non-face-to-face care coordination regulated by CPT 99490 for being eligible for the reimbursement. According to the new regulation for each beneficiary in each month, twenty minutes of non­-face-­to-­face care coordination and disease management services are mandatory for being qualified for getting reimbursed. The implications of this new condition are huge for enhancing the quality of treatment and also for increasing the revenue of care services to a significant extent.

Following this new Medicare regulation physician basically can play the role of a supervisor of a host of different healthcare services related to patient care and coordination. This new context following the CPT 99490 allows the physician to bill for the care provided, while the actual care coordination happens mostly behind the scenes by nurses and other support staffs and healthcare technicians. Naturally, from now the physicians are required to devote less time to actual patient care than earlier, while ensuring better care coordination and revenue for the care services.

This at once solved an array of crucial issues related to Medicare services. On one hand, care coordination and qualitative focus is supposed to be improved to a great extent, on the other hand practitioners will now have more available time to treat more number of patients. This surely will help improving the quality of care and the revenue for the Medicare providers and practitioners. All these benefits put together will also help increase the demand for the care coordination and remote healthcare assistance. The care coordination was always there and for physicians and healthcare staffs this is hardly a new phenomenon. But now following the condition imposed by this new regulation there is a way to reimburse the physicians and support staffs for the care they provide. This is obviously a significant impetus for all types of chronic care and patient care services.

How to get benefited from the new code?

Let us now come down to a series of practical steps and ways to get benefited from CPT code 99490. According to the regulation the practitioner first need to obtain a written consent from the beneficiary. The second and most important step is to ensure the infrastructure and capacities for providing quality CCM services. Let us offer below some of the key requirements for providing Chronic Care Management (CCM) services.

  • Using a certified electronic health record (EHR) system.
  • Providing each month to each patient 20 minutes for non-­face-­to-­face care by practitioners.
  • Offering round the clock access to care management services.
  • Better care coordination through qualified third party care providers and other support staffs.
  • Facilitating transition of care.
  • Devising separate and customized electronic care plan for each patient.

As setting up a new chronic care management ( service will need significant level of investment, expertise and experience, engaging an experiences partner in the care services can also be beneficial.

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