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New Chronic Care Managment (CCM) CPT codes

General Discussion

Last Post by cchandle 7 years ago

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rwilliams

(@rwilliams)

Posts: 454

Honorable Member

Topic starter

I am wondering if anyone else is billing the new CCM codes that came out this year and what their interpretation/results have been. We have a vendor performing the CCM services for us and their interpretation (based on an email they received from CMS) is that 99489 can only be billed once per month. Our Coding mgr states that the actual documentation states otherwise and that it can be billed once per 30min after the first 60min. I am wondering what everyone else is doing in circumstances where 120 minutes or more are being spent on a patient. Are you billing an extra 99489 and are you being reimbursed for it?

Posted : April 4, 2017 12:02 pm

ntaylor

(@ntaylor)

Posts: 79

Estimable Member

We just started using the new codes recently. I found this document helpful,

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

If you read the section related to Complex CCM, one of the bullets specifies "per calendar month". You determine which code to use based on the amount of time spend during that month for a particular patient.

Posted : April 5, 2017 2:09 am

ntaylor

(@ntaylor)

Posts: 79

Estimable Member

We just started using the new codes recently. I found this document helpful,

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

If you read the section related to Complex CCM, one of the bullets specifies "per calendar month". You determine which code to use based on the amount of time spend during that month for a particular patient.

Posted : April 5, 2017 2:09 am

cchandle

(@cchandle)

Posts: 1

New Member

I have been submitting charges for both 99487 and 99489 and they have been paid by Medicare. 99489 can be used more than once per month. You can bill for each 30 minute increment of time spent after the initial 60 minutes. The most that I have billed per patient is one 99487 with three 99489 codes in one month and this was covered 80% by Medicare. Some supplemental insurances will pick up the remainder but others will not.

Posted : June 14, 2017 12:56 am

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