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CPT Billing Codes
PCM (CPT 99426)
30 minutes or more of clinical staff time in qualifying services
Comprehensive care management services for a single high-risk disease. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan; the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization the condition requires development or revision of disease-specific care plan; the condition requires frequent adjustments in the medication regimen; and/or the management of the condition is unusually complex due to comorbidities.
CCM (CPT 99490)
20 minutes or more of clinical staff time in qualifying services
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline. Comprehensive care plan established, implemented, revised, or monitored.
Complex CCM (CPT 99487)
60 minutes
Complex chronic care management services, with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. Establishment or substantial revision of a comprehensive care plan. Moderate or high complexity medical decision making. 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
Complex CCM Add-On
(CPT 99489, use with 99487)
Each additional 30 minutes of clinical staff time
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure).
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