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CCM Coding Eligibility 99490

Timothy Posted Mon 02nd of March, 2015 14:48:48 PM

pt eligibility for CCM 99490:

I assume POS 11 will be used when submitting this code?

My question is, are patients who currently reside in an Assisted Living Facility (POS 13) and Skilled Nursing Facility (POS 31) eligible for the CCM (99490) code providing they have met all other requirements for this code?

My research to this specific question is inconclusive.

Please advise

SuperCoder Answered Tue 03rd of March, 2015 04:04:19 AM

Thank you for the query.
CCM POS is 22 (Outpatient Hospital).
As it is time based code, so can bill it separately.

Hope it helps you.

Thank you

Timothy Posted Thu 05th of March, 2015 12:12:37 PM

Please advise: Can facility bill CCM 99490 with POS 22 for pts who reside in an Assisted Living Facility or a Skilled Nursing Facility?

SuperCoder Answered Mon 09th of March, 2015 04:19:49 AM

Hi Moore,
CMS finalized with some modifications its plan to pay for monthly chronic care management services, providers will bill CPT code 99490 for calendar month chronic care management of at least 20 minutes, for patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient. These conditions must put the patient at risk of death, functional decline, or acute exacerbation. After fulfilling these criteria, it can be billed.

Hope it helps you.

Thank you

Timothy Posted Mon 09th of March, 2015 14:15:53 PM

Are patients who reside in an ASSISTED LIVING FACILITY eligible for 99490?

Are patietns who reside in a SKILLED NURSING FACILITY eligible for 99490?

Thank you

SuperCoder Answered Tue 10th of March, 2015 06:53:09 AM

Hi Moore,
As per CMS, physicians cannot bill CCM services for patients in a facility setting.
CMS says, resources required to provide care management services to patients residing in facility settings significantly overlaps with care management activities by facility staff that is included in the associated facility payment.
If an assisted living facility is receiving Medicare facility payments for a given patient residing in that facility, so you cannot report CCM for that patient.
Facility in this context is to be any health care entity- for example hospital, skilled nursing facility, etc. that receives a facility payment from Medicare.

Hope it helps you.

Thank you

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