CPT Code 99490 Description, Challenges & Best Practices

Chronic diseases are a prevailing issue in the United States, as 6 in 1 0 people are suffering from at least one chronic condition. Thus, in 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a value-based care program, chronic care management (CCM). The CPT code 99490 is a procedural code that you can report to get reimbursements under this program.

In this guide, we will discuss code 99490, its reporting issues, and some best practices to help you receive higher reimbursements without falling victim to claim rejections or denials.

So, without further ado, let’s get started!

Table Of Contents

CPT Code 99490 – Description
Common Errors & Challenges in Reporting Code 99490
Best Practices for Billing the CPT Code 99490
Bottom Line

CPT Code 99490 – Description

It is a CPT code under the range defined for CCM services and is maintained by the American Medical Association (AMA). It can be used to report the first 20 minutes of service time (non-face-to-face) delivered by a clinical staff member under the supervision of a healthcare provider per calendar month.

Common Errors & Challenges in Reporting Code 99490

In this section, we will discuss the common challenges related to the billing of CPT code 99490:

Eligibility Criteria

The eligibility criteria set forth by CMS must be met to ensure successful reimbursement of the CPT code 99490. This criteria requires providers to ensure that they bill CPT 99490 for patients with two or more chronic conditions expected to last at least a year or until the patient dies. Some of these chronic diseases are listed below:

Asthma
Atrial fibrillation
Bipolar disorder
Cancer
Chronic obstructive pulmonary disease (COPD)
Coronary artery disease
Depression
Hypertension
Peripheral arterial disease
Pulmonary fibrosis
Schizophrenia
Other neurological, renal, and endocrine conditions.

Meeting the CMS’s eligibility criteria may become challenging for providers while adhering to other billing guidelines.

Documentation Burden

Practitioners must document at least 20 minutes of physician-supervised clinical staff time (non-face-to-face) on CCM activities monthly to bill for the 99490 CPT code. However, it may become an administrative burden for healthcare providers because the documentation needs to be comprehensive, accurate, and comply with the CMS billing guidelines. Failure to provide comprehensive documentation may result in claim denials or payment delays.

Lack of Coordination

This CPT code 99490 requires the clinical staff to maintain regular communication with patients. However, maintaining consistent care coordination and communication can become challenging because each patient has two or more chronic conditions, requiring the involvement of multiple specialists for quality care.

Patient Consent

Reporting CPT code 99490 requires careful navigation since it involves acquiring patient consent for the CCM services and regularly updating the patients regarding their care plan. Regular updates help enhance patient involvement in care – an essential element of CCM.

Difficulty in Allocating Time

Since 99490 is a timed code, providers may face issues specifying the time spent on chronic care services when simultaneous tasks are performed during the session. Besides, failure to utilize time-tracking tools can also lead to under-reporting.

Best Practices for Billing the CPT Code 99490

You can easily steer clear of the issues discussed in the previous section while reporting CPT code 99490 by following the billing best practices:

Ensure Eligibility and Acquire Consent

The first step should be to ensure that the patient meets the eligibility criteria for CCM. That is, the patient has two or more chronic conditions. Next, you should obtain written consent from the patient before rendering the care service. It is essential because it helps patients understand proposed care services and the financial implications. As a healthcare provider, you can create your agreement yourself, but it must accomplish the following:

Explain all available CCM services
List down any expenses that patients will be required to pay (co-payments)
Describe the CCM billing limitations
Obtain patient consent and include the documentation in the agreement.

Focus on Comprehensive Documentation

Ensuring accurate and comprehensive documentation is the next best practice you should follow to get your rightful reimbursements for the rendered chronic care management services against CPT code 99490.

Chronic care coordination activities vary from arranging follow-up appointments to requesting and updating medical records, refilling prescriptions, etc. Thus, recording everything in detail can enhance your chances of faster payments. You can also utilize an electronic health records (EHR) system to document the following information:

Allergies
Demographics
Care coordination
Medications
On-going clinical care

Record the CCM Service Time Accurately

You must ensure the clinical staff delivers at least 20 minutes of service under physician supervision for billing the 99490 CPT code. But there’s a catch! Any time spent by the physician will NOT be recorded.

Besides, the clinical staff member must meet the below-mentioned requirements:

Supervised by a qualified healthcare practitioner
Legally qualifies to perform the care service
Should not report care services individually

Other Best Practices to Ensure Maximum Reimbursements

Here are some additional tips to help you stay on top of the billing challenges when reporting CPT code 99490:

Mention the date of service (DoS) on which the 20 minutes of chronic care service was delivered.
Use the healthcare provider’s office or location code 11 as the place of service (PoS).
Report the CPT code 99490 under Medicare Part B.
In case of claim denial, because the DoS was the same as the patient’s encounter date, you can move it to a day after without worry, as it won’t lead to any penalties.
If a denial occurs because of the Medicare Advantage Plan and the patient is also enrolled in Medicare, you can submit a claim to Medicare.

Bottom Line

Healthcare providers come across several challenges when reporting CPT code 99490 for chronic care management. From time-based coding to lack of patient consent, multiple factors can create confusion in the accurate application of this procedural code. However, some pro tips like maintaining complete documentation, meeting the eligibility criteria, and accurately timing the session can help you rise above these challenges.

If you still find it difficult to navigate, you can hire a professional medical billing company, like MediBill MD, for CCM billing services. At MediBill MD, we have a team of certified professional coders (CPCs) and billing specialists. Our team is well-versed in the CCM billing guidelines and policies, helping you ensure financial success.

Frequently Asked Questions

How often can CPT 99490 be billed to Medicare?

The CPT code 99490 only describes the minimum minutes of service required, and the maximum limit is undefined. Thus, the healthcare provider can bill only one unit of this CPT code per calendar month. Besides, only one practitioner can bill it per service period.

What is the difference between CPT codes 99490 and 99491?

The 99490 CPT code requires a physician or other qualified healthcare professional to supervise the clinical staff for performing CCM. Contrarily, CPT code 99491 can only be billed when CCM-related care is provided by the provider or other qualified healthcare professional personally. Also, both CPT codes differ in terms of the time spent, i.e., CPT 99490 requires a minimum of 20 minutes of service time while CPT 99491 is reported for a session that lasts a minimum of 30 minutes.

What is the difference between 99490 and 99487?

The CPT codes 99490 and 99487 have two distinguishing factors. First, 99490 is related to non-complex CCM service, while the latter involves moderate to high complexity decision-making. Second, the CPT 99487 requires a minimum of 60 minutes of service time, and 99490 requires only 20 minutes of service time.

How to bill 99490 and 99439 together?

Providers can bill the CPT code 99439 for each additional 20 minutes of non-complex CCM service performed by provider-directed clinical staff in conjunction with CPT code 99490. Moreover, providers can bill 99439 only twice per calendar month with CPT 99490. Thus, the total allowable billable non-face-to-face, non-complex CCM care is 60 minutes each month.

Can 99457 and 99490 be billed together?

CPT 99457 is related to patients’ remote physiological recordings and alerts that providers can report for the first 20 minutes of the time spent by the physician, clinical staff, or other qualified healthcare provider. It is a remote patient monitoring (RPM) service that you can report with CPT 99490. However, you must fulfill the time requirements for each procedural code. For instance, you must perform at least 40 minutes of care service to bill both codes together: 20 minutes for RPM code 99457 and 20 minutes for CCM code 99490.

Can you bill G0506 and 99490 in the same month?

Yes, you can bill HCPCS G0506 and 99490 in the same month. A practitioner can bill G0506 only once per patient.

Can 99490 be billed alone?

Yes, you can bill the 99490 CPT code alone.

What is CPT 99490 for Tricare?

Tricare does not cover CCM services because these services are not considered medically necessary as a separate itemized service.

CPT Code 99490 – All You Need to Know!

CPT Code 99490 – Description