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Question:
Can I bill CPT 99490 for CCM services provided to beneficiaries in facilities and to homebound patients?
Answer:

If CCM billing requirements are met and the facility is not receiving payment for care management services (for example, the beneficiary is not in a Medicare Part A covered stay), practitioners may bill CPT 99490 for CCM services furnished to beneficiaries in skilled nursing facilities, nursing facilities or assisted living facilities. The place of service (POS) on the claim should be the billing location (i.e., where the billing practitioner would furnish a face-to-face office visit with the patient). Same for homebound patients. 

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However, Care Plan Oversight and CCM cannot be billed within same month by the same provider. 

Care plan Oversight HCPCs procedure code G0181:

'Physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more'. 

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, there is no need to hold the claim until the end of the month. Even if the patient deceased within the month, but the threshold was met, CCM still can be reported. 

For complex CCM (CPT 99487, 99489), practitioners should report the service code(s) at the conclusion of the service period because in addition to specified clinical staff service time, the code(s) include moderate or high complexity medical decision-making (determined by the problems addressed by the reporting practitioner during the month). 

Initiating visit is required for new patients or those who were not seen within a year prior to the commencement of CCM – (Annual Wellness Visit [AWV], Initial Preventive Physical Examination [IPPE], Transitional Care Management [TCM] or Other Qualifying Face-to-Face Evaluation and Management [E/M]) 

Chronic Care Management (CCM) can be reimbursed to only one physician per month. 

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Insights
June 2018