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.
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