Physicians Organization welcomes new CPT code 99490 to reimburse physician-led, non-face to face clinical care for elderly patients with multiple chronic conditions

MNOHS logo 7-1-2013

New reimbursement opportunity also covers clinical team members, acknowledging movement towards team-based care in chronic care management

Media Contact: Barbara Fornasiero, EAFocus Communications, cell: 248-260-8466, barbara@eafocus.com

Rochester, Mich. – Feb. 13, 2015 –MedNetOne Health Solutions (MNOHS), a Michigan-based healthcare management organization serving the infrastructure and clinical support needs of private practice physicians and behavioral health specialists, is taking extra steps to ensure its physician members are using the new CPT code 99490 to obtain the appropriate reimbursement when they or a member of their clinical team provide non face-to-face care in the category of Chronic Care Management (CCM) services.

CMM and chronic care monitoring are an increasing focus for Centers for Medicare & Medicaid Services (CMS) as the growing Medicare population seeks treatment for multiple chronic conditions, according to Ewa Matuszewski, CEO of MNOHS.

“Effective January 1, CMS began reimbursing physicians on a per-beneficiary, per-month payment of $40.39 for non-face to face CCM services provided to patients with two or more significant chronic conditions,” Matuszewski said. “We want to make sure our physician members start getting reimbursed for these services, many of whom have been offering the services for years without being properly reimbursed. The introduction of CPT code 99490 rightly changes that.”

Covered CMM services under code 99490 which require the physician practice to have a functioning electronic medical records system, are defined as at least 20 minutes of clinical time directed by a physician or other qualified health care professional where the patient’s chronic conditions will likely last for 12 months or until the patient’s death. Such services are comprehensive and may include, but are not limited to, development and assessment of a patient’s care plan; ensuring the patient’s timely receipt of preventive care services; and medication reconciliation, with a review of adherence and potential medication interactions. Matuszewski says the new code represents a turning point of sorts in health care.

“The added significance of code 99490 is it recognizes that many types of care provided to the elderly population with multiple chronic conditions are best handled by clinicians such as dietitians, nurses, social workers or behavioral health specialists working as part of a team under the direction of a physician,” Matuszewski said. “Primary care physicians are increasingly looking at team based care as the most effective way to provide high quality, comprehensive care and CMS is responding.”

MedNetOne has created a toolkit to train and educate its members on the proper use of CPT 99490 and is also providing on-site instruction when members of its own clinical teams visit physician members.

“CPT 99490 is long overdue and, when submitted correctly, gives physicians the reimbursement they earn for the complex treatment they and their clinical teams provide to their seriously, chronically ill geriatric patients.”

About MedNetOne Health Solutions
MedNetOne Health Solutions (MNOHS), a leader in advancing the development and implementation of the Patient-Centered Medial Home (PCMH), is a health care management organization for primary and specialty care physicians and behavioral health specialists that provides administrative infrastructure and clinical support and programming to develop and sustain high performing, patient-centric practices while meeting government healthcare reform mandates. Learn more at http://www.mednetone.net.

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