What CPT code is used for 20 minutes of non-face-to-face services after a visit?

CPT Code for 20 Minutes of Non-Face-to-Face Post-Visit Services in Pediatric Behavioral Health

For 20 minutes of non-face-to-face work after a comprehensive behavioral health evaluation in a pediatric patient, use CPT code 99490 (chronic care management, up to 20 minutes per month). 1

Code Selection Rationale

CPT 99490 is specifically designed for non-face-to-face chronic care management services directed by a physician or qualified health professional for patients with complex chronic conditions, requiring up to 20 minutes per calendar month. 1 This code is particularly appropriate for this clinical scenario given:

• The patient has multiple complex chronic conditions (Autism Spectrum Disorder, ADHD, Trauma-Related Disorders, Disruptive Behavior Disorder) requiring ongoing coordination 1
• The 20-minute time frame matches exactly with the "up to 20 min per mo" specification for 99490 1
• The non-face-to-face work (report generation, care coordination, treatment planning) qualifies as chronic care management 1

Documentation Requirements

To bill 99490, you must document the specific non-face-to-face activities performed during those 20 minutes, which may include: 1

• Completion of the comprehensive behavioral health report
• Care coordination with ECAP program and child protective services
• Communication with other treating clinicians
• Development of the treatment plan and recommendations
• Scheduling follow-up comprehensive evaluations

Alternative Codes to Consider

If the patient does not meet chronic care management criteria or if your payer does not reimburse 99490, consider these alternatives: 1

• 99401-99404 (preventive medicine counseling): Time-based codes for counseling separate from a preventive visit, though these typically require face-to-face contact 1
• Prolonged services codes: May be applicable if the non-face-to-face time extends beyond the base E/M visit time, though specific prolonged non-face-to-face codes have limited applicability in this context 2, 3

Critical Caveats

The American Academy of Pediatrics warns that 99490 may not be reimbursed by some insurance plans, including Medicaid. 1 In these situations, you have two options:

• Document the total time spent (face-to-face plus non-face-to-face) and use time-based coding for the primary E/M visit if >50% was dedicated to counseling 1
• Bill the base E/M code only and absorb the additional 20 minutes as practice overhead 1

For complex chronic care management requiring more extensive time (60+ minutes per month), consider CPT 99487 instead, which reimburses at a higher rate. 1 However, this requires documenting a full 60 minutes of non-face-to-face time per calendar month.

Billing Strategy

Always verify with the patient's specific insurance carrier whether they reimburse 99490 before providing the service, as reimbursement policies vary significantly. 1 The Centers for Medicare and Medicaid Services covers this code, but commercial payers and Medicaid programs may have different policies. 1

Document the exact start and stop times of your non-face-to-face work, the specific activities performed, and how they relate to managing the patient's chronic conditions. 2, 3 This documentation is essential for audit protection and claim adjudication.