CMS Finalizes Reimbursement Criteria for Non-Face-to-Face Chronic Care Management

For the first time, CMS is reimbursing for non-face-to-face chronic care management (CCM) services. This reimbursement will pay separately for non-face-to-face care coordination furnished to Medicare beneficiaries with two or more chronic conditions. CMS discussed this new policy in 2013 but did not include a specific reimbursement policy until now.

The specific code for this service, CPT 99490, is defined as “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; comprehensive care plan established, implemented, revised, or monitored.”

A payment rate of ~$42 could be billed once per month per qualified patient.

Read more…A PYA white paper on reimbursement for chromic care management:
http://www.pyapc.com/resources/collateral/white-papers/Chronic-Care-Whitepaper-PYA.pdf