According to a recent article in ashp.org, the time that a pharmacist spends providing medication management when not face-to-face with the patient counts toward the monthly minimum to bill Medicare for chronic care management.
Code 99490—Chronic care management services
, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, 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.
“I think a pharmacist would definitely meet the term clinical
,” said Ann Marshall, of the Centers for Medicare and Medicaid Services (CMS).
On January 1, 2015, chronic care mangement services became billable by CMS
. CMS’s decision to pay separately for care management of beneficiaries with two or more chronic conditions came from the agency’s stated belief about resource use and the CPT evaluation and management (EM) codes; that is, EM codes describe face-to-face visits and do not reflect any of the time spent managing chronic conditions when the patient is not physically present.
Why a pharmacist’s time counts.
Physician practices wanting a definitive answer on whether their pharmacists count as clinical staff for Medicare purposes should talk with the local Medicare administrative contractor, CMS’s Marshall advised.
As for the term clinical staff
, she attributed it to the CPT codebook
The codebook, published by the American Medical Association, states: “A clinical staff member is a person who works under the supervision of a physician or other qualified healthcare professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service.”
See more at: ahsp.org
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