The Centers for Medicare & Medicaid Services (CMS) made important changes in 2021 to expand access to Chronic Care Management (CCM) services, including new reimbursement rules.

Non-Complex Care

For non-complex care, CMS has added a new code (99439), to account for an additional 20 minutes of clinical staff time per month on top of the initial 20 minutes (99490). This new code can be used up to two times per month, allowing you to bill for 60 minutes of total staff time.

Below is a breakdown of the billing structure your practice can use for 2021:

For 20 minutes: bill 99490 for a total of $42.00 (or G0511 for RHCs and FQHCs for a total of $67.02)
For 40 minutes: bill 99490 plus 99439 for a total of $79.80
For 60 minutes: bill 99490 plus 99439 twice for a total of $117.60

Note: when billing for CCM, you must have two ICD-10s listed for the patient.

To avoid confusion when billing, ThoroughCare automatically adjusts the corresponding codes required when a patient has reached 20, 40, 60 and 90+ minutes of care. This prevents any mistakes in the billing process and ensures maximization of revenue for your practice.

Complex Care

For complex care, the rules have remained unchanged from 2019. Below is a breakdown of the billing structure your practice can use for 2021:

For 60 minutes of complex care: bill 99487 for a total of $93.00

For 30 additional minutes: bill 99489 for a total of $46.49

Thus, to bill for 90 minutes of complex care, you would bill 99487 the first 60 minutes plus 99489 for the additional 30 minutes, bringing the total to $139.49 ($93.00 + $46.49).

Note: For complex care, there is no cap on how many minutes you can bill for.

For CCM, here's what we recommend, and how ThoroughCare creates claims:

At 20 minutes: Bill 99490 (or G0511 for RHCs and FQHCs)

At 40 minutes: Bill 99490 + 99439

At 60 minutes: Bill 99490 + 99439 (x2)

At 90 minutes: Bill 99487 + 99489

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