Advancing The Profession of Pharmacy

99491: The New Chronic Care Management Code on the Block

by | Feb 7, 2019 | Consulting Pharmacist Education

 

Today we’re discussing the newest CCM Code 99491.

So if you remember the “regular” CCM code 99490, codes for about 20 minutes of a non provider clinical staff member visit with a patient enrolled in a chronic care management aka CCM program.

This is a once monthly non face to face visit with a patient that generally reimburses for about $42.

 

As of January 2019 the Centers for Medicare and Medicaid introduced a new code for CCM: 99491.

The “little sister” 99490 is for 20 minutes of non provider contact with a patient. The new one 99491 is for 30 minutes of directly involved with the provider’s care so it needs to be provided by the qualified health care professional instead of clinical staff member.

At this point I would not recommend that pharmacists be able to bill for the 99491 code since in most states we do not have qualified health care provider status.

The difference in reimbursement, however is quite generous.

If you are practicing with a provider who spends a little bit of extra time with the patient and is much more involved in a home visit in a given month you can use the higher reimbursing code.

Whereas the 99490 code reimburses for about $42 dollars the new one reimburses for between $74 and $84 dollars.

Almost double what you would be paid for the 20 minute 99490 visit.

We expect to see this code being used in conjunction with the 99490 when on a certain month the provider must be more involved.

 

However the 99490 and 99491 codes cannot be used together in the same calendar month.

 

Additionally if you’ll refer back to our complex and chronic care management code video you know there’s also a complex code 99487 that codes at a higher rate for a more complicated patient visit.

This code cannot be used at the same time as a 99491 visit either so CMS wanted to give providers who are more involved in the patient’s care a chance at the higher reimbursement.

Then if the next month it can return to clinical staff member or in XYZ duties they can continue and go back billing to the 99490 code.

So if you’re interested in learning more about chronic care management check out our past videos on chronic care management and complex chronic care management codes and

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About the Author

Blair Thielemier, PharmD, is an MTM consultant pharmacist specializing in pharmacy billing models. She consults on and produces e-learning programs for state and national organizations, pharmacy wholesalers, payers, technology start-ups. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at PharmapreneurAcademy.com. She speaks internationally about trends in leveraging pharmacists to improve value-based care.

 

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