Bethesda, MD (May 18, 2015) – HFSA Issue Brief - Chronic Care Coordination

Effective January 1, 2015, Medicare will pay for chronic care management (CCM) services – non-face-to-face services to Medicare beneficiaries who have multiple, significant, chronic conditions (two or more).  Chronic care management services include regular development and revision of a plan of care, communication with other treating health professionals, and medication management.

CMS has established a payment rate of $42.60 for CCM that can be billed once per calendar month per qualified patient.

CCM services are to be reported with CPT 99490.  This is a new provision as CMS had proposed the use of a G Code for the reporting of services.  The basics of this new CCM benefit include:

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, with 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.

The CCM and non-face-to-face portion of the CCM services provided by clinical staff incident to the services of a practitioner may be furnished under the general supervision of a physician or other practitioner.

CMS will require the version of the certified electronic health record (EHR) that is in use on December 31 of the prior calendar year for the EHR Incentive Programs to bill for CCM services.

For a complete list of all the service requirements that must be met to bill this code, see Table 33 of the Final Medicare Physician Fee Schedule rule, viewed here.

The Centers for Medicare and Medicaid Services (CMS) has developed a CCM coding document and a frequently asked questions document.  We encourage you to use these important tools as a reference to ensure correct coding for CCM services.

To view the Frequently Asked Questions about Billing Medicare for Chronic Care Management Services, please go here.

A revised Fact Sheet can also be accessed here.