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Up-to-date CPT codes, values and requirements for administrators & practitioners to optimize billable encounters and quality care
The Centers for Medicare and Medicaid Services (CMS) recognizes the importance of more continuous care for patients, preventatively and beyond the point of care. Therefore, CCM services tend to complement face-to-face patient visits, focusing on characteristics of advanced primary care. They are:
Yes, a regular co-pay does apply, making it about eight dollars per month for the patient. For many, supplemental insurance will cover this co-pay. Additionally, we are waiting on the final ruling from CMS, but legislatures in Washington are working to eliminate co-payment requirements.
CCM services are directed by a physician or other qualified healthcare professional. Physicians and some non-physician practitioners: certified nurse-midwives; clinical nurse specialists, nurse practitioners; and physician assistants may bill for CCM services. Specialty practitioners may provide and bill for CCM.
CMS requires the billing practitioner to furnish an annual wellness visit (AWV), initial preventative physical examination (IPPE), or comprehensive evaluation and management visit to the patient before billing the CCM service and to initiate the CCM service as part of this exam/visit. Once the consent form is signed and the required elements are performed, the first month of CCM can be billed..
Traditional Medicare and most Medicare Advantage plans are currently reimbursed for CCM services.
Yes. Specific care settings do not allow CCM billing because the resources required to provide care management services to patients in facility settings significantly overlap with facility staff's care management activities included in the associated facility payment. These include nursing homes and skilled nursing facilities, and when the patient is an inpatient in the hospital. Other restrictions include when the patient is receiving hospice or has end-stage renal disease services. Transitional care management can be billed with 99490, as long as the service date does not overlap.
No. Videos pushed to patients are NOT compliant and do not count toward the 20+ non-face-to-face meeting minutes. The only time that counts is time spent by clinical staff or the biller. Per CMS, "CPT 99490 is not counting or paying for time by the patient doing anything; it is only time by clinical staff (or the biller themselves) doing qualifying activities within one of the scope of the service elements."