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).”