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These criteria include: The observed increase in claims for a HCPCS or CPT code year-to-year meets the definition of significant, anomalous, and highly suspect billing activity, as defined elsewhere in this section of this proposed rule

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[96] Therefore, we based the proposed inputs on CPT code 99490 multiplied by 5/12 (or, five units ( over 12 months), plus CPT add-on code 99439 ( CCM services each additional 30 minutes by clinical staff directed by a physician or other qualified health care professional, per calendar month ) multiplied by 1/6 (or two units), plus CPT add-on code 99489 ( Complex CCM services each additional 30 minutes by clinical staff directed by a physician or other qualified health care professional, per calendar month ) multiplied by 1/12 (one unit), plus CPT code 99487 ( Complex CCM services provided by clinical staff directed by a physician or other qualified health care professional, per calendar month ) multiplied by 1/12 (one unit)

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