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CPT Codes

CPT ( Current Procedural Terminology) Connected Codes

In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions.

REMOTE PATIENT MONITORING


CPT 99457 - $54

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

CPT-99453 - $21

Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc) initial; setup and patient education on use of equipment.

CPT-99454 - $69

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s)or programmed alert(s) transmission, each 30 days.


CHRONIC CARE MANAGEMENT


CPT 99490 - $42

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. The billing physician (or other appropriate billing practitioner) provides CCM services directly, that time counts towards the 20 minute minimum time. Of course, other staff may help facilitate CCM services, but only time spent by clinical staff may be counted towards the 20 minute minimum time.

CPT 99487 - $94

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

CPT 99489 - $47

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).

HCPCS G0506 - $64

Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure)


TRANSITIONAL CARE MANAGEMENT


CPT 99495 - $165

Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

CPT 99496 - $234

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)


COMMUNICATION TECHNOLOGY-BASED SERVICES


HCPCS G2012 - $10

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management (E/M) services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion)

HCPCS G2010 - $13

Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment)


In a general sense, Chronic Care Management encompasses any care provided by healthcare professionals to patients with chronic diseases and health conditions, such as fibromyalgia, diabetes, multiple sclerosis, lupus, and high blood pressure. The primary goal is to help patients, via therapies and interventions, to live with less pain related to their chronic conditions – to achieve a better quality of life through ongoing care and management of their conditions.



The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions.



Only one practitioner may be paid for CCM services for a given calendar month. This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both).


For Medicare purposes, non-complex and complex CCM services share similar elements, differing only in the amount of clinical time and expertise required per calendar month.


Practitioner Eligibility Physicians and the following non-physician practitioners may bill CCM services: ● Certified Nurse Midwives ● Clinical Nurse Specialists ● Nurse Practitioners ● Physician Assistants NOTE: CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. The CCM service is not within the scope of practice of limited license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care. CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the billing practitioner), subject to applicable State law, licensure, and scope of practice.
The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM. Time spent directly by the billing practitioner or clinical staff counts toward the threshold clinical staff time required to be spent during a given month in order to bill CCM services. Non-clinical staff time cannot be counted toward the threshold.