CPT® Code 99490 is used to report non-face-to-face chronic care management (CCM) services provided by a physician or qualified healthcare professional for patients with two or more chronic conditions. This code covers at least 20 minutes of clinical staff time per calendar month spent on care coordination, medication management, and patient support.
CCM services aim to improve health outcomes, reduce hospitalizations, and ensure continuity of care for patients with complex chronic conditions.
Key Facts About CPT® 99490
- Service type: Non-face-to-face chronic care management
- Provider type: Physicians and qualified healthcare professionals (QHPs)
- Medical services included: Yes—care planning, coordination, and management for chronic conditions
- Time requirement: Minimum 20 minutes per calendar month
- Patient type: Patients with two or more chronic conditions expected to last at least 12 months or until death
- Common clinical indications:
- Diabetes with hypertension
- Congestive heart failure with chronic kidney disease
- COPD with hyperlipidemia
- Multiple chronic illnesses requiring ongoing care coordination
When to Use CPT® 99490
CPT 99490 is appropriate when:
- The patient has two or more chronic conditions
- Clinical staff spend at least 20 minutes per calendar month on care management activities
- Activities include medication reconciliation, care coordination, patient education, and follow-up
- Services are non-face-to-face and do not overlap with other E/M visits for the same period
Examples:
- Reviewing lab results, updating care plans, and coordinating with specialists for a patient with diabetes and CHF
- Conducting monthly check-in calls to monitor medications, adherence, and symptom changes
- Coordinating referrals, preventive care, and follow-up appointments for multiple chronic conditions
Documentation Requirements
To support CPT 99490 billing, documentation should include:
- Patient identifiers and date(s) of service
- Chronic conditions being managed (must meet the two-condition requirement)
- Total time spent on care management activities
- Specific care coordination tasks performed
- Follow-up plans, medication reconciliation, and patient education
- Provider or clinical staff credentials
Accurate documentation ensures compliance, supports reimbursement, and promotes safe, coordinated care.
Reimbursement and Coding Considerations
- CPT 99490 is covered by Medicare and most commercial insurers when medically necessary
- Time-based billing is required; only count time spent on non-face-to-face CCM services
- Only one provider may bill for CCM per patient per month
- CCM may be billed alongside other E/M visits, but time must not overlap
- Patient consent for CCM services is typically required
Always verify payer-specific CCM policies and time-tracking requirements before billing.
How OptiMantra Supports Chronic Care Management
OptiMantra’s integrated EMR and practice management system streamlines documentation and billing for CPT 99490:
With OptiMantra, providers can:
- Track chronic care management activities and time spent per patient per month
- Document chronic conditions, care plans, and care coordination tasks
- Generate compliant, audit-ready CCM billing codes
- Monitor patient adherence, follow-up, and health outcomes
- Maintain longitudinal records for complex patients with multiple chronic conditions
By centralizing CCM workflows, OptiMantra helps practices improve care quality, ensure compliance, and optimize reimbursement for non-face-to-face chronic care services.
Try OptiMantra for free here!
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