More answers to questions about chronic care management

The Centers for Medicare & Medicaid Services (CMS) this month released a set of frequently asked questions (FAQs) about the chronic care management (CCM) service for which Medicare began paying this year.

The FAQs reaffirm some of what was already known about CCM and clarify other areas. For instance, regarding date of service and when to submit claims for CCM, answer No. 4 states, in part, “practitioners may bill . . . at the conclusion of the service period or after completion of at least 20 minutes of qualifying services for the service period. When the 20 minute threshold to bill is met, the practitioner may choose that date as the date of service, and need not hold the claim until the end of the month.”

The CMS FAQs also clarify the prohibition on reporting CCM for “facility” patients. For instance, answer No. 6 notes, in part, “CPT code 99490 cannot be billed . . . for services provided to [skilled nursing facility] inpatients or hospital inpatients, because the facility is being paid for extensive care planning and care coordination services.” The answer goes on to say, however, that if the patient is not an inpatient the entire month, time that is spent furnishing CCM services to the patient while he or she is not an inpatient can be counted towards the minimum 20 minutes of service time that is required to bill for that month. Several other questions and answers address when it is acceptable to report CCM under the Medicare hospital outpatient prospective payment system.

Like the CMS fact sheet on CCM, the CMS FAQs emphasize that CCM must be initiated by the billing practitioner during a comprehensive evaluation and management (E/M) visit, annual wellness visit, or initial preventive physical exam (i.e., Welcome to Medicare visit). During an open door forum call for physicians, nurses, and allied health professionals on May 13, CMS staff clarified that, for purposes of CCM, “a comprehensive E/M visit” could be any face-to-face E/M service with a physician, including 99212-99214.

For more information on Medicare’s CCM service, including links to related content in Family Practice Management, check out the related web page on the American Academy of Family Physician’s web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family