2025 CPT code 99490
(Active) Effective Date: N/A Revision Date: N/A Chronic Care Management - Care Management Services Evaluation and Management Feed
Chronic care management services; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
Modifiers may apply depending on the circumstances of service delivery. Consult the CPT manual and payer guidelines for appropriate modifier usage.
Medical necessity is established when the patient has two or more chronic conditions that meet the criteria outlined in the code description and require ongoing care management to prevent acute exacerbations, hospitalizations, or functional decline.
Clinical staff, under the direction of a physician or other qualified healthcare professional, provide chronic care management services. The physician or qualified professional oversees the care plan and directs the clinical staff's activities.
- Evaluation and Management
- Evaluation and Management > Care Management Services > Chronic Care Management
In simple words: This code covers the first 20 minutes of time spent each month by nurses or other healthcare staff, directed by a doctor, managing a patient's ongoing health problems. The patient must have at least two long-term health issues that put them at high risk for serious problems or death. The staff helps create and follow a care plan to manage these issues.
This CPT code reports chronic care management services provided by clinical staff under the direction of a physician or other qualified healthcare professional.The services must include at least 20 minutes of clinical staff time in a calendar month.The patient must have two or more chronic conditions expected to last at least 12 months or until death, placing them at significant risk of death, acute exacerbation/decompensation, or functional decline. A comprehensive care plan must be established, implemented, revised, or monitored.This code is for the initial 20 minutes; additional time is reported using CPT code 99439.
Example 1: A 68-year-old patient with type 2 diabetes and hypertension receives 25 minutes of clinical staff time for medication reconciliation, blood glucose monitoring education, and care coordination with a nephrologist., A 72-year-old patient with congestive heart failure and COPD receives 35 minutes of clinical staff time for reviewing lab results, coordinating home health visits, and providing patient education on disease management., A 55-year-old patient with rheumatoid arthritis and depression receives 20 minutes of clinical staff time spent in telephone calls to coordinate physical therapy appointments, medication refills, and mental health follow-up.
Documentation should include:patient's chronic conditions, assessment of risk, established care plan, minutes spent on each care management activity by clinical staff, and evidence of care coordination.
** This code should only be reported once per calendar month per patient, even if more than 20 minutes of clinical staff time is spent.It is crucial to maintain accurate documentation supporting the time spent on each activity, as well as the patient's chronic conditions, and risk assessment.
- Payment Status: Active
- Specialties:Internal Medicine, Cardiology, Endocrinology, Family Medicine, Geriatrics, Pulmonology
- Place of Service:Office, Home, Assisted Living Facility, Skilled Nursing Facility, Telehealth