Q/A: Service Period for 99490

June 6th, 2022 - Chris Woolstenhulme
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Question:  If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim?

Answer:   According to CMS, “The service period for CPT 99490 is one calendar month, and CMS expects the billing practitioner to continue furnishing services during a given month as applicable after the 20-minute time threshold to bill the service is met. However, practitioners may bill the PFS at the conclusion of the service period or after completion of at least 20 minutes of qualifying services for the service period. When the 20-minute threshold to bill is met, the practitioner may choose that date as the date of service and need not hold the claim until the end of the month.” In addition, the add-on codes may be billed after the initial 20 minutes, for each additional minute up to 60 minutes using 99439, or each additional minimum 30 minutes of physician or other qualified health care professional time using 99437 with 99491.  Other billing considerations:  The billing practitioner cannot report both complex CCM and non-complex CCM for a given patient for a given calendar month. Do not report 99491 in the same calendar month as 99487, 99489, 99490

The following CPT codes are reported during the calendar month:

99490 at least 20 minutes of clinical staff time - care management activities.

99491 at least 30 minutes of physician or other qualified health care professional time personally spent in care management.  

Add-on codes may be reported as well for any time spent in addition to the primary CPT codes reported. Add-on code 99439 is reported with 99490 for each additional 20 minutes of clinical staff time spent in care management activities during the calendar month up to a maximum of 60 minutes total time (may be reported twice per calendar month).  Add-on code 99437 is reported with 99491 for each additional minimum 30 minutes of physician or other qualified health care professional time.

NOTE: If reporting 99437, and 99491 DO NOT include any time devoted to the patient and/or family on the date that the reporting physician or other qualified health care professional also performed a face-to-face E/M encounter.

Resources:

Chronic Care Management Services MLN909188https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdfCMS- FAQs on Chronic Care Managementhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/payment-chronic-care-management-services-faqs.pdf

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