Chronic care management


Several changes to the scope of service elements for chronic care management (CCM) clarify or simplify Medicare’s billing requirements. For code 99490, “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 … ,”

For CCM services that require more clinical staff time, more complex medical decision-making, and more substantive care planning than 99490, Medicare is extending payment to two codes:

  • 99487, “Complex chronic care management services, 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; establishment or substantial revision of a comprehensive care plan; moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month,”
  • +99489, “Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure).”


Vaginal Colposcopy

Vaginal Colposcopy
Endoscopic examination of the entire vagina.

Includes evaluation of the entire vaginal wall with various degrees of magnification. Surface area of the vagina (much greater than that of the cervix with much marked surface irregularity) has high complexity due to time requirements and physician work associated with constant refocusing and change of speculum and colposcope position to maximize visualization of the vagina.

Viewing cervix is not reported separately (an inclusive component of codes 57420, and 57421)

Report cervix endoscopy codes (57452, 57454) for primary examination of the cervix

Physical Therapy CPT Codes in the same 15 minutes time period

1. Billing – CPT Codes:

Not Permitted In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients. Examples include:

a. Any two CPT codes for “therapeutic procedures” requiring direct one-on-one patient contact (CPT codes 97110-97542);

b. Any two CPT codes for modalities requiring “constant attendance” and direct one-on-one patient contact (CPT codes 97032 – 97039);

c. Any two CPT codes requiring either constant attendance or direct one-on-one patient contact – as described in (a) and (b) above — (CPT codes 97032- 97542). For example: any CPT code for a therapeutic procedure (eg. 97116-gait training) with any attended modality CPT code (eg. 97035-ultrasound);

d. Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 – 97542) with the group therapy CPT code (97150) requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112);

e. Any CPT code for modalities requiring constant attendance (CPT codes 97032 – 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035);

f. Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 – 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)

Medicare/Medicaid Credentialing

Before providers can bill for Medicare or Medicaid services, they must become credentialed. The application process includes filling out several forms, which are lengthy and can be confusing especially if applying for group or corporate entities.

PECOS revalidation – One of the recent Medicare requirements is for physicians to be enrolled in PECOS (Provider Enrollment Chain Ownership System). PECOS is an electronic system in which Medicare contractors enter provider Medicare enrollment information. If a physician is enrolled in Medicare or has updated his/her Medicare enrollment information within the past five years, this information may or may not be stored in PECOS. If a physician enrolled more than five years ago and have not submitted any updates to Medicare, he/she will need to update his/her Medicare enrollment information and may actually need to revalidate your provider information.

We can take care of this entire process from beginning to end. Providers simply need to provide us with information regarding their practices (tax id, NPI, License, etc).