Hello,
I have been coding Chronic Care Management for almost 4 years. We use codes 99490 and 99439 (and rarely 99487). Within the past almost 2 years we have become PDCM certified so we began billing telehealth codes 98966,98967,98968 for PDCM eligible patients with BCBS, BCBS Medicare Advantage, and Priority Health members. It has been brought to my attention that now Medicare may pay / reimburse the 98966,67,68 codes. The nurses that do this work want to look into starting to bill these for Medicare patients. My question is, does anyone do this already ? Have you heard of it. And why would we bill the 98966,67,68 codes in replacement to our CCM codes 99490,99439? The original guidelines for CCM was 2 chronic conditions, at least 20 minutes of work for the month, these telephone codes require only 5 minutes (minimum) of work, 1 diagnosis, does not have to be a chronic condition. Below I have posted some back ground information, and am interested to hear reasons why we would switch (or go back and forth?) between the CCM codes and the PDCM codes. Any thoughts/ knowledge is appreciated!
99490 - $41.99
20+ minutes/month of CM work
99439-
addtl 20 minutes of work after 99490
99487 - $92.69
60+ minutes/month of CM work “complex code”
99489 - $44.76
each 30 minutes/month of CM work “complex code” – no limit to the qty for this code
98966 - $14.38
5-10 minute call by HCP
98967 -$27.71
11-20 minute call by HCP
98968 - $40.48
21-30 minute call by HCP
I have been coding Chronic Care Management for almost 4 years. We use codes 99490 and 99439 (and rarely 99487). Within the past almost 2 years we have become PDCM certified so we began billing telehealth codes 98966,98967,98968 for PDCM eligible patients with BCBS, BCBS Medicare Advantage, and Priority Health members. It has been brought to my attention that now Medicare may pay / reimburse the 98966,67,68 codes. The nurses that do this work want to look into starting to bill these for Medicare patients. My question is, does anyone do this already ? Have you heard of it. And why would we bill the 98966,67,68 codes in replacement to our CCM codes 99490,99439? The original guidelines for CCM was 2 chronic conditions, at least 20 minutes of work for the month, these telephone codes require only 5 minutes (minimum) of work, 1 diagnosis, does not have to be a chronic condition. Below I have posted some back ground information, and am interested to hear reasons why we would switch (or go back and forth?) between the CCM codes and the PDCM codes. Any thoughts/ knowledge is appreciated!
99490 - $41.99
20+ minutes/month of CM work
99439-
addtl 20 minutes of work after 99490
99487 - $92.69
60+ minutes/month of CM work “complex code”
99489 - $44.76
each 30 minutes/month of CM work “complex code” – no limit to the qty for this code
98966 - $14.38
5-10 minute call by HCP
98967 -$27.71
11-20 minute call by HCP
98968 - $40.48
21-30 minute call by HCP