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CPT Code 99490 The description of CPT code 99490 is as follows, chronic care management services with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, Comprehensive care plan established, implemented, revised, or monitored
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Reimbursement and Coding Considerations CPT 99406 is time-based and requires documentation of 3 to 10 minutes of counseling Modifier -25 must be appended to the E/M code when cessation counseling is provided on the same day as a separate E/M service CPT 99407 should be used instead if counseling exceeds 10 minutes Coverage is commonly provided by Medicare and many commercial payers Diagnosis codes related to tobacco use (e.g., nicotine dependence) should support medical necessity Proper coding ensures accurate reimbursement and compliance with payer requirements
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