Congratulations on managing CCM with athenahealth and ThoroughCare!  Submitting claims is really simple, but it's important to make sure that your Fee Schedule is set up correctly.

Here's how to check your Fee Schedule in athenahealth (per their article):

  1.  On the Main Menu, click the Settings icon . Under ADMIN, click Billing. In the Task Bar, under PRACTICE LINKS — Fee and Allowable Schedules, click Fee Schedules

  2. Find your active Fee Schedule and click:  "Edit Procedure Fees".

  3. Filter for the 4 CCM codes (listed below) to make sure they are in the list.  If they aren't in the list, you'll need to add them.

CCM Procedure Codes for your fee schedule:

  1.  99490:  CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH

  2.  G2058:  CHRON CARE MANAGEMENT SRVC ADDITIONAL 20 MIN PER MONTH (UP TO TWO TIMES MAX - ADDITIONAL 40 MIN TOTAL)

  3.  99487:  COMPLEX CHRON CARE MANAGEMENT W/O PT VISIT 60 MIN

  4.  99489:  COMPLEX CHRON CARE MANAGEMENT ADDL 30 MINS

Sample Screenshot of adding the new 99487 Procedure Code
(you can use our descriptions above when adding these codes)

What amount should we use when creating these codes?

The average nationwide reimbursement for these codes are as follows:

  1.  99490:  $42.00

  2.  G2058:  $37.80 (x2 = $75.60)

  3.  99487:  $93.67

  4.  99489:  $47.01

Medicare will only pay you what the reimbursement is worth in your area.  So we recommend you "round up" to make sure you receive the full amount.

Since these rates differ by geographic area, we highly suggest that you find the rates for your specific area.  Here is the physician fee schedule on the CMS website.  

https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

On that page, you can filter by Locality to find your specific area.

Did this answer your question?