7 FAQs About Chronic Care Management

1. What is Chronic Care Management?

Chronic Care Management (CCM) is care coordination that occurs outside of standard office visits for patients living with two or more chronic conditions that are expected to last at least one year (or until death). CCM, a crucial component of primary care for Medicare beneficiaries, aims to reduce overall healthcare costs by keeping patients healthy and out of the emergency room.

2. Which Services Does CCM Include for Medicare Patients?

CCM services for Medicare patients include medication management, coordination of patient information and referrals between different care teams, preventive health planning, and symptom management. CCM patients also have access to a member of their medical team 24 hours a day, seven days a week for any urgent health concerns that arise.

3. Which Providers Can Bill for CCM Under Medicare?

Physicians, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and physician assistants can provide and bill CCM services. Other healthcare professionals not listed can provide and bill CCM, as long as they do so under the supervision of the billing practitioner.

4. What Qualifies as a Chronic Condition Under CCM Guidelines?

Under CCM guidelines, a chronic condition can be expected to last at least 12 months, requires continuous and/or intensive medical care, and cannot be easily cured.

Some Examples of Eligible Chronic Conditions Include:

• Alzheimer’s disease
• Asthma
• Cystic fibrosis
• Post-traumatic stress disorder (PTSD)
• Substance use disorders
• Crohn’s disease
• Diabetes
• Chronic kidney disease
• Cancer
• Hypertension

5. What Are the Required Steps for Implementing CCM?

Implementing CCM requires three steps: Confirming patient eligibility and obtaining consent, establishing a care plan, and submitting a claim to Medicare.

1. Confirm Patient Eligibility and Obtain Consent

Firstly, after the patient’s eligibility has been confirmed during an initial in-person visit, the provider must obtain consent (either verbal or written) from the patient to begin receiving monthly CCM services.

2. Establish a Care Plan

Secondly, once consent has been given, the provider prepares a detailed care plan that addresses the patient’s individual health needs and establishes health management goals. This time can also be used to educate the patient about their chronic conditions and help them understand how to use their care plan to stay out of the hospital and on track with their health goals.

3. Monitor and Bill

Lastly, the provider administers continuous care to keep an eye on the patient’s medication adherence, recommend lifestyle changes, and update the care plan as needed. Finally, the provider submits a claim to Medicare for CCM reimbursement.

6. What is the Difference Between Non-Complex CCM and Complex CCM?

Non-complex CCM covers routine chronic condition management with standard clinical decisions. Complex CCM typically involves higher-intensity decision-making, more frequent medication adjustments, and a more detailed care plan than non-complex CCM.

7. What Are the Billing Codes for CCM?

CCM is billed under six CPT codes, split between non-complex (99490, 99439, 99491, 99437) and complex (99487, 99489) services.

Non-Complex CCM Billing Codes:

CPT 99490 includes at least 20 minutes of non-face-to-face clinical staff time, directed by a physician or other qualified healthcare professional, per calendar month.

CPT 99439 serves to bill each additional 20 minutes beyond the initial 20 minutes included in CPT 99490, but not enough to be classified as complex CCM.

CPT 99491 includes at least 30 minutes of either face-to-face or non-face-to-face time between the provider and patient.

CPT 99437 serves to bill each additional 30 minutes beyond the initial 30 minutes included in CPT 99491.

Complex CCM Billing Codes:

CPT 99487 includes at least 60 minutes of clinical staff time per calendar month and is typically used for complex medical decision-making that involves creating or revising a care plan.

CPT 99489 serves to bill each additional 30 minutes beyond the initial 60 minutes included in CPT 99487.