What is CPT Code 99490?
The
Current Procedural Terminology (CPT) code 99490 is designated for chronic care management (CCM) services. This code is used to bill for non-face-to-face care coordination services provided to patients with multiple (two or more) chronic conditions that are expected to last at least 12 months, or until the death of the patient. These conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Creating, revising, and monitoring a comprehensive
care plan Medication management
Providing patient and/or caregiver education to support self-management
Coordination with home and community-based services
Communication with other healthcare providers
These services are critical in ensuring that pediatric patients with chronic conditions receive continuous and coordinated care.
The patient must have two or more chronic conditions expected to last at least 12 months.
A comprehensive care plan must be established, implemented, revised, or monitored.
At least 20 minutes of clinical staff time must be spent on care coordination activities within a calendar month.
Documentation of these activities is essential for proper billing and reimbursement.
Improved
care coordination and quality of care
Enhanced patient and family satisfaction
Reduced hospitalizations and emergency room visits
Better management of medication and treatment plans
These benefits can lead to improved health outcomes and a better quality of life for pediatric patients with chronic conditions.
Documentation requirements can be time-consuming and complex.
Reimbursement rates may not always cover the costs associated with providing comprehensive care management.
Coordination of care across multiple providers and settings can be challenging.
Engaging families and caregivers in the care plan requires ongoing effort and communication.
Addressing these challenges requires a dedicated approach and effective use of healthcare resources.
Conclusion
CPT code 99490 offers a valuable framework for providing chronic care management services in pediatrics. By meeting the required criteria and effectively documenting care activities, pediatricians can enhance care coordination and improve health outcomes for children with chronic conditions. Despite some challenges, the benefits of using CPT 99490 in pediatric care make it a worthwhile endeavor for healthcare providers. For more detailed information, consult the
American Medical Association guidelines or your local healthcare regulations.
