Case Management Society of America

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Medicare Fee-for-Service Program

Centers for Medicare & Medicaid Services Resource

BY CMSA TODAY STAFF

As of January 1, 2015, chronic care management services are covered under the Medicare Physician Fee Schedule, American Medical Association Current Procedural Terminology (CPT) code 99490. Under this new code, Medicare pays separately for non-face-to-face care coordination services consisting of at least 20 minutes of clinical staff time directed by physician or other qualified health care professional.

The code is an initial step in supporting physicians and their practice in managing Medicare patients with multiple chronic conditions who are at the highest risk of functional decline or death.

CMSA first told you about the new code in October 2014, in which CMSA Today published ‘Understanding the Chronic Care Management Codes,’ by CMSA Executive Director Cheri Lattimer. The article provided information on the then proposed code under the FY2015 Medicare Physician Fee Schedule, as well as its significance to case managers and their patients.

Centers for Medicare & Medicaid Services has published a fact sheet detailing the code’s use under the Medicare Fee-for-Service Program, including eligible providers and patients as well as billing requirements.

The fact sheet also provides background on the newly payable chronic care management (CCM) service. Examples of chronic conditions include, but are not limited to, the following:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Heart failure
  • Hypertension
  • Ischemic heart disease
  • Osteoporosis     ■

PHOTO COURTESY CENTERS FOR MEDICARE & MEDICAID SERVICES.

Beginning January 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. CPT 99490 is defined as outlined above.

Visit tinyurl.com/ChronicCareManagement to access the full Chronic Care Management Services fact sheet by CMS.