Snow storm

While many of us may be grappling with a seemingly brutal and endless winter, some sunshine may be on the horizon. Healthcare providers today are faced with the challenges of a growing patient population with multiple comorbidities on the one hand, while keeping  rising costs and resource pressures at bay. But there may be a bright spark in all this in the form of a new billing code.

Effective January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a new billing code (CPT code 99590)  and began paying for chronic care management (CCM). It seems that CMS is paving the way to ease the transition from a fee-for-service model to a capitated model by incentivizing providers to deliver better, more comprehensive care. Under the new ruling, providers who deliver care management services to patients with at least two chronic conditions, including the creation of a care plan, remote review of patient progress (e.g., by phone or internet), and follow-up, are now eligible to bill approximately $40 per patient per month for the duration of the care management program.

This new billing code is significant in several ways:

  1. It encourages clinicians to engage patients beyond the regular office visit,

  2. It relies upon the use of processes and tools that are patient-centered, and,

  3. It will drive the use of information technology, from EMRs to telemedicine and patient engagement tools

The roll-out of this new billing code both validates a long-standing hypothesis we have had about the importance of chronic care management, and opens the door for us and our peers to develop tools that support providers in delivering and getting reimbursed for chronic care management services. Judging from recent discussions with providers, there is a great deal of excitement surrounding this new billing code and the potential revenue stream it creates for clinicians. We are just as excited and look forward to hearing about providers who have successfully used the code to bill!

For more information on CPT code 99490, this link on CMS education site contains a helpful slide deck explaining the details.