Chronic Care Management (CCM) is now a unique Physician Fee Schedule (PFS) service designed to pay separately for 20 minutes of non face-to-face care coordination services furnished to Fee for Service Medicare beneficiaries with multiple (2 or more) chronic conditions expected to last 12 months or more.  Non Facility Based, non-geographic base fee is $ 42.60 per month, so your new revenue opportunity will depend on geographic region, there are other requirements and co-insurance does apply.

Vivify Health’s Platform and BYOD solution with flexible electronic care plan meets many of the Scope of Service Requirements for capturing this new reimbursement, which could add tens of thousands of additional revenue to physician practices or hospital outpatient departments (HOPDs).  Combined with a Certified EHR we can help you meet all the Scope of Service Requirements.

There is still a lot of misinformation being published, but based on guidance from CMS* and the American Telemedicine Association* we can give the following guidance on the most common billing misconception. CPT code 99490 cannot be billed during the same service period as CPT codes 99495–99496 (transitional care management), Healthcare Common Procedure Coding System (HCPCS) codes G0181/G0182 (home health care supervision/hospice care supervision), or CPT codes 90951–90970 (certain End-Stage Renal Disease services). Also consult CPT instructions for additional codes that cannot be billed during the same service period as CPT 99490. There may be additional restrictions on billing for practitioners participating in a CMS sponsored model or demonstration program.

Resources:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1516.pdf

Recommended Posts

No comment yet, add your voice below!


Add a Comment

Your email address will not be published. Required fields are marked *