As a solo primary care doctor, Melissa Lucarelli, MD, rarely turns down an opportunity to increase her practice’s revenue. But that’s what she did when, in 2015, Medicare introduced its new billing code for chronic care management (CCM).
She certainly welcomed the code’s purpose: reimbursing providers for the time spent managing the care of patients with multiple chronic conditions. But the restrictions attached to use of CPT code 99490—such as obtaining a patient’s written consent to participate, tracking the time spent on each patient and requiring an $8 monthly patient copay—led Lucarelli to conclude that it wasn’t worth the time and effort for a small independent practice such as hers.
“It seemed like a cruel joke,” Lucarelli, a Medical Economics editorial adviser, recalls thinking at the time. “It’s like they were saying, ‘we have this money available but you’re never going to be able to get it.’”
But Medicare subsequently eased some CCM billing requirements—for example, allowing providers to obtain verbal rather than written consent from patients before providing services billed to the code. And it raised the reimbursement amount for the original code and added new ones with the potential for practices to earn even more from providing the services.
Those changes led Lucarelli, at the suggestion of a staff member, to look again at whether billing CCM could be cost-effective. She decided to give it a try.
The results so far have exceeded Lucarelli’s expectations. After less than a year her practice, based in the rural town of Randolph, Wisconsin, is earning about $4,600 per month from providing chronic care management services to 113 Medicare patients. The additional income has enabled her to hire a part-time care manager and to purchase some new equipment and furnishings for the practice.