Pediatric Coding Alert

If your payer follows CMS rules, then Marshall’s advice during the agency’s webinar can help guide your pediatric practice’s navigation of the coding and billing regulations for these services. Although most private insurers haven’t shared as much comprehensive information about 99490 as CMS has, some payers have published information about the services, and we’ve broken down some samples below to get you started in your research.

Blue Cross Blue Shield of North Carolina: This payer says that 99490 is considered “incidental to other evaluation and management services and not eligible for separate reimbursement.”

WellPoint: This payer is only covering 99490 for its Medicare accounts.

Anthem and EmpireBlue: For its commercial contracts, Anthem and EmpireBlue will not be reimbursing 99490, but the code is “an integral component” of the insurers’ value-based payment innovation programs.

Ohio Medicaid: Reimburses 99490 at a maximum payment of $32.81

Texas Medicaid: This payer lists 99490 as not payable for pediatricians.

Best bet? Check your insurers’ websites or call them for details in writing about CCM coverage.