CPT® has added 99491 to the section of chronic care management codes. The other code in this section is 99490 and there are two codes in the complex chronic care management section, 99487 and 99498. This article will discuss CPT® 99491.
For in-depth information about existing codes, read our feature about chronic care management here on CodingIntel.
Review of existing codes, 99490, 99487, 99489
99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
- Comprehensive care plan established, implemented, revised, or monitored.
This code is used for clinical staff time, directed by a physician/NP/PA, when the clinical staff member has spent 20 minutes in the activity in a calendar month. The payment is relatively low with wRVUs of .61, for the direction of the clinical staff work, and a non-facility national payment of about $42.
99487 Complex chronic care management services, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
- chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
- establishment or substantial revision of a comprehensive care plan,
- moderate or high complexity medical decision making;
- 60minutesofclinicalstafftimedirectedbyaphysician or other qualified health care professional, per calendar month.
+ 99489 each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
99487 and 99489 are also for when the CCM services are provided by clinical staff under the direction of a physician. The patient’s condition is assumed to be more complex than required for 99490, and the time thresholds are higher.
There is a CPT® Coding Tip related to 99497 and 99489,
“If the physician personally performs the clinical staff activities, his or her time may be counted toward the required clinical staff time to meet the elements of the code.”
The codes are valued, however, with the assumption that the work is being performed by clinical staff, under the direction of the practitioner. 99487 has wRVUs of 1.00 and a non-facility, national rate of about $93 and 99489 has a wRVU of .5 and a national, non-facility rate of about $47.
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