Maximizing CPT Code 99490


How Our Practice Did, and How Yours Can, Too

By now industry professionals are likely familiar with CPT code 99490, the new Centers for Medicare and Medicaid Services (CMS) code that reimburses physicians for many previously unpaid services they provide to Medicare patients, including medication reconciliation and the gathering of medical records and reports from other physicians treating Medicare patients.

Like many small and medium-sized physician practices, ours believed the time and effort needed to gather and keep track of the patient information needed to get reimbursed would outweigh the financial benefits to our practice. We were also skeptical that Medicare patients would be willing to buy into the chronic care management (CCM) program, which typically costs the average Medicare patient about $8 out of pocket.

Nevertheless, we set out to explore options, and we’re glad we did. We uncovered a cost effective solution that not only helps us comply with CPT code 99490, but also helps us deliver more effective patient care and provides us with more than $20,000 a year in increased revenues.

What You Need to Know

First, some background. Statistics show that the average Medicare beneficiary with two or more chronic conditions sees anywhere from five to seven providers. With CPT code 99490, CMS is seeking to boost care efficiency for these patients in particular. In return for coordinating patient care provided by all these physicians, each “lead physician” can bring in about $41 per patient, per month, in added revenue.

Unfortunately, the perceived challenges associated with CPT code 99490 are keeping many physician practices, especially small and medium-sized ones like ours, from jumping on board.

However, many practices don’t realize that they don’t have to take on the entire burden alone. Our practice has been able to maximize our ROI by leveraging a solution developed by CareSync to handle many of the tasks needed to comply with the code.

These include gathering medical records and other documentation, an especially time-consuming and labor-intensive task for smaller and mid-sized practices with smaller staffs and fewer resources. Previously, if I needed a GI colonoscopy report, I’d have to call for it myself or ask my staff to track it down; today, I can simply access and download it from the web portal to my printer.

CCM’s value in this regard helped us to sell the benefits of CPT code 99490 to our clinical and administrative staff wary of the code’s documentation requirements. This approach to CCM independently collects data uploaded from each patient’s providers and doesn’t significantly impact the day-to- day routine. The most significant impact on staff comes at the end of the month, when the report on patients that have qualified for reimbursement arrives and goes to my billing staff to bill out the CCM codes.

Improving Patient Buy-In

Similarly, we’re finding it easier to sell patients on the benefits of CCM. The program is still new, and many patients don’t understand what they’re being asked to sign up for. In addition to explaining to patients their eligibility for CCM, we explain how we can better manage their care with the availability of 24-hour patient access to a registered nurse for questions and concerns, as well the full access that they, their physicians and designated caregivers get to all the patient’s charts. Combined, these strategies improve overall buy-in for patients, which ultimately is what makes this approach important.

For example, I have a patient who loves the little beep he gets from his phone on arrival of an update to his records. He’s always coming in and asking me if I’ve looked at the portal to see his latest visit to the local hospital for his chemotherapy treatment or another specialist visit. This eager engagement is what drives patient buy-in home, fostering a sense of excitement in patients to continue improving their personal health outcomes.

Positive Impacts Across the Board

Ultimately, our entire practice and our CCM patient population are enjoying a very positive impact. The mundane tasks of records requests and med reconciliations—long the bane of our staff’s existence—have largely been off-loaded by a CCM approach that works in the background. I can spend less time inputting data and tracking down records, and more time talking to my patients about their health and other circumstances surrounding their condition and treatment.

From a financial perspective, this approach enables the CCM reimbursement to pay for itself, but a residual comes back on each patient that we qualify for CCM each month. As a result, I estimate we’re now bringing in an extra $20,000 to $25,000 a year. With that money, we’re then able to pay for additional patient resources and staff to focus more directly on patient care.

An Opportunity for Reimbursement

Ultimately, CMS wants physicians to better manage our chronic care population, and the only way we can do that is by getting more resources. In private practices, and even in multi-specialty practices, resources are in short supply. The government talks about fixing payment formulas, but for the most part, things just keep getting cost shifted.

CPT code 99490 represents the most significant opportunity in many years that physicians can get reimbursed for time being spent on tasks that previously went unpaid. To that end, we’re maximizing every resource at our disposal.


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About Author

Michael Paul Gimness, MD

Michael Paul Gimness, MD, is a family medicine physician at Family Medical Specialists of Florida, PLC.

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