Neurology & Pain Management Coding Alert

Question: In the chronic care management code 99487, the descriptor mentions ‘60 minutes of clinical staff time per calendar month.’ Please describe who is considered to be clinical staff. Can we consider the billing physician to be ‘clinical staff’ and count the time spent for chronic care management?

Ohio Subscriber

Answer: According to CPT^®, clinical staff implies those who work ‘under the supervision of the physician or qualified healthcare professional.’ This may include physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives. If your physician provides the chronic care management services, you can count the time for code 99487 (Complex chronic care management services, with the following required elements:… 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month). In this case, the billing physician services are counted as clinical staff services.

Check for the incident-to rules:  Before you count the time of the clinical staff for the code 99487, make sure the service qualifies for Medicare’s incident-to criteria, such as supervision by a physician and scope of practice.