99490

Chronic Care Management Services, 20 minutes

Chronic Care Management (CCM) services for patients with multiple (2 or more) chronic conditions that are expected to last at least 12 months, or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. This code represents the first 20 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month, for non-face-to-face care coordination services. These services involve establishing, implementing, revising, or monitoring a comprehensive care plan.

Clinical Indications

  • Patients with two or more chronic conditions (e.g., diabetes, hypertension, heart failure, COPD, arthritis, depression) expected to last at least 12 months.
  • Patients whose chronic conditions place them at significant risk of death, acute exacerbation/decompensation, or functional decline.
  • Patients requiring ongoing, comprehensive, and coordinated care management to address complex health needs and reduce the risk of adverse health outcomes.

Procedure Steps

  1. Obtain patient consent for CCM services, including explanation of cost-sharing and privacy practices.
  2. Establish, implement, revise, or monitor a comprehensive care plan specific to the patient's chronic conditions, including a problem list, expected outcomes, prognosis, measurable goals, symptom management, and planned interventions.
  3. Provide 24/7 access to urgent care needs for the patient and/or caregiver.
  4. Perform medication reconciliation and management, including reviewing prescriptions, over-the-counter medications, and supplements.
  5. Manage care transitions between providers and settings, including referrals to other clinicians and follow-up after hospital discharge.
  6. Coordinate care with home health agencies, other community-based clinical service providers, and social support services.
  7. Educate the patient and/or caregiver on the patient's condition(s), care plan, and self-management techniques.
  8. Document all care management activities, including time spent by clinical staff, in the patient's electronic health record (EHR).

Coding Guidelines

  • CPT code 99490 is reported once per calendar month for at least 20 minutes of clinical staff time spent on non-face-to-face care coordination activities.
  • Patient consent must be obtained and documented prior to initiating CCM services.
  • Services must be provided under the general supervision of a physician or other qualified health care professional.
  • A comprehensive care plan must be established, implemented, revised, or monitored. This plan must be shared with the patient and/or caregiver.
  • The billing practitioner must utilize a certified EHR to document and manage patient information.
  • CPT 99490 cannot be reported on the same date of service as certain other care management codes, including Transitional Care Management (99495, 99496), Home Health Care Plan Oversight (99605), Hospice Care Plan Oversight (99606), or certain ESRD services.
  • Additional time beyond the initial 20 minutes can be reported with add-on code 9949X (if applicable, check current year's codes for specific add-on for additional minutes).

Associated ICD-10 Codes