7 FAQs About Chronic Care Management

According to the Centers for Disease Control and Prevention (CDC), a staggering four in 10 Americans live with at least two chronic conditions, making them a major contributor to the nation's $4.5 trillion in annual healthcare costs and a leading cause of death. Fortunately, many Medicare beneficiaries are eligible for Chronic Care Management services that help them manage their chronic conditions more effectively and improve overall well-being. Let’s dive into the fundamentals of Chronic Care Management and address some frequently asked questions.

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 Are Included in CCM?

CCM includes 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. Who Can Provide and Bill CCM Services?

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 Counts as a Chronic Condition Under CCM Guidelines?

A chronic condition is one that is 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 Steps Are Required for Implementing CCM?

1. Confirm Patient Eligibility and Obtain Consent

   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

   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 empower them to take full advantage of the care plan for optimal health benefits.

3. Monitor and Bill

   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?

CCM is classified as either non-complex or complex, based on the intensity and complexity of the services performed. Complex CCM typically involves high-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?

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. 

CCM Benefits Patients and Providers

Chronic Care Management brings numerous benefits for patients and providers alike, most notably improved patient health outcomes and opportunities for practices to generate additional revenue through Medicare reimbursements. Utilizing an AI-driven Chronic Care Management platform allows care teams to get the most out of CCM by streamlining billing, scheduling, and administrative tasks – ultimately opening up more time for direct patient care.

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