Chronic care management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.
The Centers for Medicare & Medicaid Services (CMS) recognizes that CCM is a critical component of primary care that promotes better health and reduces overall health care costs.
The four CPT codes used to report CCM services are:
CCM services that must be documented in the electronic health record (EHR). Covered services include, but are not limited to:
Shares common required service elements with CCM, but has different requirements for:
Only one health provider who assumes the care management role for a beneficiary can bill for providing CCM services to that patient in a given calendar month. While services are provided by a clinical staff person, the service must be billed under one of the following:
Non-physicians must legally be authorized and qualified to provide CCM in the state in which the services are furnished.
Chronic care management can help manage your patients’ chronic conditions more effectively, improve communication among other treating clinicians, and provide a way to optimize revenue for your practice. Learn how time spent coordinating referrals, refilling prescriptions, and taking calls or emails from patients and caregivers can contribute towards the required time to bill CCM.
Read more about chronic care management in the Making Sense of MACRA: Simplifying Chronic Care Management (CCM) supplement.
The AAFP’s advocacy efforts helped pave the way for Medicare payment for CCM, giving family physicians an opportunity to be paid for the many services they provide outside of traditional face-to-face office visits. The AAFP believes that family physicians should be compensated for the value they bring to their patients by delivering continuous, comprehensive, and connected health care.
Medicare beneficiaries who qualify for CCM services benefit from additional support and resources that help them manage their chronic conditions effectively. More coordinated care leads to better health and decreased overall health care costs. As the health care system transitions from a fee-for-service model to value-based payment, billing CCM services makes it possible for you to be paid for the time and effort you and other care team members invest in caring for your patients who have chronic conditions.