What is required to bill CPT99490?
Chronic care management services, at least 20 minutes of clinical staff 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


CCM Service Elements - Highlights


The CCM service is extensive, including structured recording of patient health information, maintaining a comprehensive electronic care plan, managing transitions of care and other care management services, and coordinating and sharing patient health information timely within and outside the practice. CCM services are typically provided outside of face-to-face patient visits, and focus on characteristics of advanced primary care such as a continuous relationship with a designated member of the care team; patient support for chronic diseases to achieve health goals; 24/7 patient access to care and health information; receipt of preventive care; patient and caregiver engagement; and timely sharing and use of health information.


Structured Recording of Patient Health Information​
Record the patient’s demographics, problems, medications, and medication allergies using certified Electronic Health Record (EHR) technology. 

Comprehensive Care Plan

  • A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment, and an inventory of resources (a comprehensive plan of care for all health issues, with particular focus on the chronic conditions being managed)
  • Provide the patient and/or caregiver with a copy of the care plan
  • Ensure the electronic care plan is available and shared timely within and outside the billing practice to individuals involved in the patient’s care

Access to Care & Care Continuity

  • Provide 24-hour-a-day, 7-day-a-week (24/7) access to physicians or other qualified health care professionals or clinical staff, including providing patients (and caregivers as appropriate) with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of week
  • Ensure continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments
  • Provide enhanced opportunities for the patient and any caregiver to communicate with the practitioner regarding the patient’s care by telephone and also through secure messaging, secure Internet, or other asynchronous non-face-to-face consultation methods (for example, email or secure electronic patient portal) 


Comprehensive Care Management

  • Systematic assessment of the patient’s medical, functional, and psychosocial needs
  • System-based approaches to ensure timely receipt of all recommended preventive care services
  • Medication reconciliation with review of adherence and potential interactions
  • Oversight of patient self-management of medications
  • Coordinating care with home and community based clinical service providers


Source: https://www.cms.gov/.../Medicare.../ChronicCareManagement.pdf

Large Untapped Addressable Market 

  • Since 1/1/15, CMS pays an average of $43/month to deliver 20+ minutes of non-face-to-face care coordination for Medicare beneficiaries with 2 or more chronic conditions.  With over 33,000,000 eligible members, this is a new $17B market.


Value to Physicians
Most of the 209,000 primary care physicians cannot meet the technology and services requirements to bill for this new code. This doesn’t even include the number of specialists who can also utilize this code.  Less than 1% of these physicians are taking advantage of this program. With our partner’s assistance, on average, providers can earn $250K+ for every 500 patients annually.

Want to join DP Resources in Chronic Care Management?

​Please call or email:
Diane Plante, President
DP Resources, Inc. / DP Medsolutions 
www.DPMedSolutions.com
Diane@dpmedsolutions.com
941-240-8407
FAX 888-850-7585

 

What is Chronic  Care Management? 
The Centers for Medicare and Medicaid Services (CMS) recognizes chronic care management (CCM) as one of the critical components of primary care that contributes to better health and care for individuals as well as reduce spending. 

On January 1, 2015 The Centers for Medicare and Medicaid Services (CMS) created billing code CPT99490 to cover CCM.

CPT99490 is Here to Stay...CPT9940 is 100% paid for by Medicare. “We are committed to supporting primary care and we have increasingly recognized care management as one of the critical components of primary care that contributes to better health for individuals and reduced expenditure growth.”
- CMS, 77 FR 68978.