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Medicare billing code CPT 99490 has enormous potential to help primary care physicians improve the well-being of their most vulnerable patients; but the requirements are stringent. Be sure your practice is aligned with the following.(Disclaimer: this guideline is not intended as a legal document.)

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CPT Code 99490 Requirements Checklist Worksheet: Medicare billing code CPT 99490 has enormous potential to help primary care physicians improve the well-being of their most vulnerable patients; but the requirements are stringent. Be sure your practice is aligned with the following. (Disclaimer: this guideline is not intended as a legal document.)

Must provide at least 20 minutes of non-face-to-face CCM services per month that are tracked separately from other forms of care: must coordinate records with all healthcare providers.

Must notify eligible patients (on Medicare, 2 or more chronic conditions) and obtain

written consent prior to supplying or billing the service. Informed patient consent is only necessary to be obtained once prior to supplying the CCM service OR if the patient chooses to change the practitioner who will supply and bill the service.

Must document discussion of service in medical record along with consent or refusal.

Discussion must cover: That only one practitioner can offer and be paid for the service during a calendar

month How cost-sharing (co-insurance and deductibles) applies to these services being

provided How to rescind the service

Must document the outcomes of each call into EMR record including history,

medications and clinical care.

Must provide a 24/7 access portal for patients to view records online and instruct patients how to access their information.

Must provide a systematic assessment of the patients medical, functional and psychosocial status as well as medication compliance tracking

A typical systematic assessment should review appointments, problems, medications, allergies, directives, and alerts and flags.

Source: DEPARTMENT OF HEALTH AND HUMAN SERVICES Chronic Care Management Services information PDF

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