As per Centers for Medicare & Medicaid Services (CMS), Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions. Beginning January 1, 2019, the CPT codes are:
- CPT 99490
- CPT 99491
- CPT 99487
- CPT 99489
CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. The CCM service is not within the scope of practice of limited-license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care. Physicians and the following non-physician practitioners may bill CCM services:
- Certified Nurse Midwives
- Clinical Nurse Specialist
- Nurse Practitioners
- Physician Assistants
Billing practitioners may consider identifying patients who require CCM services using criteria suggested in CPT guidance (such as number of illnesses, number of medications, or repeat admissions or emergency department visits) or the profile of typical patients in the CPT prefatory language.
There is a need to reduce geographic and ethnic disparities in health through provision of CCM services. The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex CCM during a given service period, not both. Do not report 99491 in the same calendar month as 99487, 99489, 99490.