A Financially Sustainable Solution

Comprehensive assessment and care planning for patients requiring chronic care management services; billed once in conjunction with an office visit (E/M service).

First 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month.

Each additional 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month (report separately in addition to code 99490; code 99439 may be reported up to twice per calendar month).

First 60 minutes of clinical staff time, under the direction of a physician or other qualified health care professional, per calendar month, involving substantial revision of a care plan and moderate to high complexity medical decision-making.

Each additional 30 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month (to be listed separately in addition to code 99487).

Initial setup and patient education for remote monitoring of physiological parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), including instruction on equipment usage.

Supply of device(s) with daily recordings or programmed alert transmissions, billed in 30-day increments. Includes monitoring for a minimum of 16 days within the 30-day period.

First 20 minutes of clinical staff time in a calendar month requiring interactive communication with the patient/caregiver during the month.

Additional 20 minutes of clinical staff time in a calendar month requiring interactive communication with the patient/caregiver during the month.

APCM Level 1: for Medicare patients with one or fewer chronic conditions; can be billed every calendar month as long as APCM services are available to patients.

APCM Level 2: for Medicare patients with 2 or more chronic conditions; can be billed every month as long as APCM services are available to patients.

APCM Level 3: for Qualified Medicare Beneficiaries (QMB) with 2 or more chronic conditions; can be billed every month as long as APCM services are available to patients.