Plotting Your Course for 99490 Requirements
Chronic Care Management (CCM) Services
CMS defines CPT code 99490 as "Chronic care management services, at least 20 minutes of none-face-to-face 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." (CMS Final Rule, October 31, 2014.)
*Faxing no longer meets requirements for acceptable electronic means of communications.
**If physician determines that the patient is eligible for CCM services, physician must discuss CCM services with the patient during their Annual Wellness, Initial Preventive Physical Exam, or Comprehensive Evaluation and Management visit.
INFORMED WRITTEN CONSENT
- Before CCM services begin, the billing practitioner must explain the program to eligible patients and obtain written agreement.
24 / 7 ACCESS TO CCM SERVICES
- Ensure 24/7 access to CCM services, providing the patient with a means to make timely contact with health care practioners in the practice who have access to the patient’s electronic care plan to address his or her chronic care needs.
- Ensure continuity of care with a designated practitioner or member of the care team with whom the patient is able to get successive routine appointments.
STRUCTURED DATA RECORDING
- Record the patient’s demographics, problems, medications, and medication allergies and create structured clinical summary records using certified EHR technology.
20 MINUTES / NON-FACE-TO-FACE
- A minimum of 20 minutes documented time per month. (Does not need to be face-to-face, or office-based care time.)
- Record start and stop times, a short description of services provided and who performed the service.
- Provide medication reconciliation with review of adherence and potential interactions.
- Oversight and tracking of patient’s self-management of medications.
MANAGEMENT OF CARE TRANSITIONS
- Manage care transitions between and among health care providers and settings, including referrals to other providers.
- Provide follow-up after an emergency department visit, and after discharges from hospitals, skilled nursing facilities, or other health care facilities.
- Coordinate care with home and community-based clinical service providers.
Source - Go.CMS.gov/MLNProducts: ICN 909188 May 2015