CMS relaxes certain requirements for billing under CPT code 99490

The Centers for Medicare and Medicaid (CMS) recently determined some of their requirements for billing under the Medicare chronic care management CPT code 99490 to be too burdensome for eligible clinicians.

Medicare began paying for Chronic Care Management on January 1, 2015. The code allows providers to bill for 20 minutes of non-face-to-face coordination per Medicare patient with two or more chronic conditions, per month. (See our resources on billing for CPT code 99490.) These providers are then reimbursed about $43 per month, per patient. The provider who bills under CCM, in a sense, plays “quarterback” on a team of caregivers treating an individual patient with multiple chronic conditions, in the spirit of value-based reimbursement.

Chronic Care Management

Physicians had displayed concerns that time requirements to gather and coordinate data with other physicians to form a single plan isn’t worth the monetary benefit of billing for CCM. So far, only 275,000 patients have received the service, reportedly.

CMS decided to relax the following two requirements:

  1. That providers have 24/7 access to their patients’ records
  2. That certified EHRs be used to share clinical-care summaries when moving patients from one provider to another. Clinicians who bill under CPT code 99490 will be required to share records with other clinicians in a timely manner, instead.

CMS stated that the organization’s decision was the result of concern that “imposing EHR-related requirements at the service level as a condition of … payment could distort the relative valuation of services priced under the fee schedule … [We] recognize that other CMS initiatives may be better mechanisms to incentivize increased interoperability of health information systems than conditions of payment assigned to particular services under the [physician fee schedule.]”

A new bipartisan bill has also been introduced in the House recently that would let high-deductible insurance plans with health savings accounts allow pre-deductible coverage for managing chronic diseases.

We at MediTouch have strived to consistently make all EHR-related requirements stress-free for our users – including the requirements encompassed in Chronic Care Management. Many physicians who use MediTouch have already found success billing under CCM, since we’ve provided the tools for practices to implement an efficient and compliant system, from day one. Now, with these more relaxed requirements, there’s no reason not to bill for CPT code 99490 when treating chronically ill patients.


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