Payment Chronic Care Management Services FAQs - CMS

March 17, 2016 Frequently Asked Questions about Billing Medicare for Chronic Care Management Services This document answers frequently asked questions about billing Chronic care Management (CCM) Services to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) under CPT code 99490. Physician Fee Schedule 1. CPT code 99490 requires at least 20 minutes of time per calendar month by clinical staff in order to bill the code. Who qualifies as clinical staff ? If the billing physician (or other appropriate practitioner) furnishes Services directly, does their time count towards the required minimum 20 minutes of time? In most cases, we believe clinical staff will provide CCM Services incident to the Services of the billing physician (or other appropriate practitioner who can be a physician assistant, nurse practitioner, clinical nurse specialist or certified nurse midwife). Practitioners should consult the CPT definition of the term clinical staff.

by clinical staff external to the practice (for example, in a case management company) if all of the “incident to” and other rules for billing CCM to the PFS are met. Because there is a regulatory

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  Management, Clinical, Incident

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