Provider Alerts - January 2, 2019

New Authorization Requirements – Chronic Care Management Services

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Date: January 2, 2019
To: Health Plan of San Joaquin (HPSJ) PCPs From: HPSJ Medical Management Department
From: HPSJ Medical Management Department
Subject: New Authorization Requirements – Chronic Care Management Services
Business: Medi-Cal

Effective March 4, 2019 HPSJ’s benefit coverage for Chronic Care Management, CPT code 99490, will require a prior authorization. Chronic care management services are provided when medical and/or psychosocial needs of the patient require establishing, implementing, revising, or monitoring the care plan.  

CPT 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) has a frequency limit of once per month and must meet 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 

 Our HPSJ network providers are important partners in delivering care to our members. We hope this change will be helpful for you and your practice. If you have questions, please contact our Customer Services Department at 209-942-6320.

REMINDERS:  
To refer an HPSJ member to Case Management, Social Work, or behavioral health services, please call 209-942-6352 or connect online at https://www.hpsj.com/diseasemanagement/.  

You also can refer members through the DRE portal. Follow this path: 

    • Complete patient search 
    • Click “Referral”
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