- Reimbursements (upbeat music)
for Chronic Care Management are tied to CPT codes.
At first glance, these codes can be confusing
or intimidating, but here at ThoroughCare,
we're here to get you through it.
In this video, we'll break down everything you need to know
about CPT codes for Chronic Care Management,
so you can properly bill for this program
and maximize your revenue.
Hey, there!
This is Loran with ThoroughCare.
Here at ThoroughCare, we help groups just like yours,
to manage value-based programs like Chronic Care Management.
Knowing the billing codes for CCM
will give you a better idea of what's expected
by both your group and by Medicare.
Understanding billing codes,
will also help you optimize your staff's capacity,
while increasing revenue.
CPT codes for Chronic Care Management will vary
by the time spent with the patient
throughout the calendar month.
At times, it can also vary by who at your staff,
or at your group, is providing services.
There are three series of CCM codes
that you'll need to be made aware of:
CCM non-complex, complex, and physician-driven codes.
One major thing to consider
when actually dropping these claims
to your insurance carriers,
is that a series of CCM codes can only be billed
once per calendar month.
So for example, you can't bill physician-driven codes
with complex, or non-complex codes.
If you bill more than once,
you run the risk of that claim being denied
by the insurance.
We, here at ThoroughCare, suggest you drop the claim
with the highest reimbursement
at the end of the calendar month.
Another important aspect of Chronic Care Management billing,
is to use at least two ICD-10 codes with that CPT code.
This ICD-10 code will be tied
to the conditions you're managing for the patient's CCM.
So again,
at least two ICD-10 codes are required for billing,
but if you are managing more than two,
you will need an ICD-10 code for each condition managed.
Let's start with the non-complex clinical staff CCM codes.
Now what exactly is clinical staff?
We, at ThoroughCare, suggest
that someone who is logging this time
be at least a certified resource or higher.
So think CMA, CNA,
or anybody higher than that at your practice.
Code 99490, you might be aware of.
This code has been around
since the dawn of the program in 2015,
and has largely remained unchanged since then.
99490 takes into account 20 minutes
of non-face-to-face or CCM time done by the clinical staff.
The current national average reimbursement is around $62.
Now again, keep in mind, it might vary in your area.
There is also an add-on code now for code 99490
known as code 99439.
99439 is an add-on code for 99490 only,
and it can be counted
after an additional 20 minutes is acquired
on top of the initial 20 minutes.
This code can first be billed at 40 minutes,
so you'll bill using code 99490 and 99439.
Adding 99439 will add $47 of extra reimbursement
on top of that initial 62.
You can bill 99439 up to two times per calendar month,
so either 40 or 60 minutes.
So you'd simply bill 99490 and 99439 times two.
This adds another $47,
and the total national average reimbursement
will be around $156 for the 60 minutes of non-complex time.
If you are a rural health clinic
or federally-qualified health center,
you won't use those codes.
You will simply bill code G0511.
This is a general care coordination code.
As an FQHC or RHC, this is the only code you can bill
for Chronic Care Management.
G0511 is at least 20 minutes of non-face-to-face
or CCM time, and even if you accrue 40, 60-plus minutes,
you can only still bill G0511 one time per calendar month.
The good news in 2022
that this reimbursement has been increased to $76.94.
Now, let's move to CPT codes for complex CCM.
Some of your patients might need more care than others,
and some patients, you might be managing three,
four, or five-plus conditions within a calendar month.
In this case, you'll use the complex code
for 60 or 90-plus minutes.
At 60 minutes of complex CCM,
you're going to bill using code 99487.
99487 pays at a national average reimbursement of $132.
Now there is an add-on code to 99487 only,
using code 99489.
99489 is an additional 30 minutes of time
on top of the initial 60 minutes of complex time.
You can bill 99489 an unlimited time
within the calendar month.
So 90, 120, 150-plus minutes,
you would simply add code 99489 on top of 99487.
Code 99489 will pay 70 additional dollars
on top of the 99487 claim reimbursement.
Now, at this point in the video, you may have noticed
that we mentioned 60 minutes of time twice:
one complex, one non-complex.
So what do we do in this situation?
Well, here at ThoroughCare, we suggest
that you bill code 99490 plus 99439 times two.
Now there are two reasons why we suggest that.
The first is that, hey, it ultimately pays more.
So you can see the differences in reimbursements here
between the two codes.
Also, using 99490 and 99437 times two,
you're taking the complexity of decision-making
out of the equation.
So, many of our customers feel more comfortable
at that point, even if they don't feel
that their patient is a complex CCM patient.
And finally, let's go over the CCM CPT codes
for physician-driven CCM care.
If your physicians are more hands-on,
or they spend non-face-to-face time with the patients,
while they're out of the office,
you may want to bill for these codes.
The first physician-driven CCM code you can bill for,
is at 30 minutes of physician-only time,
and that is code 99491.
Again, 30 minutes of physician time only
can be counted toward this code.
Currently the national average reimbursement
for 99491 is $83.
New in 2022, there is a 30 minute add-on code,
an additional 30 minutes
on top of the initial 30 minutes, using code 99437.
Again,
this takes into account 30 minutes extra provider time
on top of the first 30,
and the national average reimbursement
for this add-on code is $59.
Now that you know more about the CPT codes for CCM,
it might be time for you to find a software solution,
that can help you streamline the billing process.
If you're interested in a care coordination software,
you may wanna check out our free buyer's guide,
that'll give you a better idea of what to look for
when considering a CCM solution.
It's a download on our website,
and you can also see it in the links below.
You can also check our Learning Center
with clinician-written articles answering the questions
that are most frequently asked to us,
here at ThoroughCare, on a daily basis.
If you have any questions, please feel free to comment below
and a ThoroughCare representative will reach out to you.
Don't forget to subscribe and like this video.
If there's anything else we can help you with,
please feel free to reach out and thanks for watching.
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