CPT-99490

CHRONIC CARE MANAGEMENT

CPT 99490 is billed to the patient receiving chronic care management who must have a minimum of two or more chronic regular or intermittent health conditions that precede to last at least one year or until the patient expires. These conditions may put the patient at increased risk of death, exacerbation, or functional decline. Chronic care management services include the establishment, implementation, revision, and monitoring of a comprehensive patient care plan.

COMPONENTS

The provider performs a physical examination, management of medications, and communicates with other treating healthcare professionals. They also provide patient education, patient self-management, and prognosis of ongoing conditions.

CODING CRITERIA

For CPT 99490, the following criteria should be met:

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
• For this CCM service, a minimum of 20 minutes of clinical staff time directed by a physician or other qualified health care professional is required
• The CPT 99490 can be reported only once per calendar month

BILLING CRITERIA

Providers cannot bill 99490 more than once a month
EXCLUDES

• The CCM services defined by CPT codes 99491 & 99437 cannot be billed with 99490
• For time less than 20 minutes the CPT 99490 cannot be billed

ADD ON CODE

In case of service provided for more than the first 20 minutes, CPT code 99490 requires to add on Code 99439 for each additional 20 minutes