The ABC’s of Chronic Care Management

Chronic Care Management is the non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more), significant chronic conditions. Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for CCM services. This began January 1, 2015. Code 99490 relates to 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. The services require the patient to have two or more chronic conditions that are expected to last at least 12 months, the conditions place the patient at significant risk or death or functional decline, and a comprehensive care plan needs to be established and monitored. Some conditions that might meet this code are: Alzheimer’s Disease, Arthritis, Asthma, Cancer, Diabetes, Hypertension or Osteoporosis.

A consent for CCM services must be signed by any patient and the patient must be notified that only one doctor may bill for this service during a calendar month. The patient must also be given instructions on how to revoke the service. CMS also requires that the billing physician furnish a comprehensive evaluation and management (E/M) visit, Annual Wellness Visit, or Initial Preventive Physical Examination (IPPE) to the patient prior to billing the CCM service.

CMS requires the use of a version of certified EHR that is acceptable under the EHR Incentive Programs as of December 31st of the calendar year preceding each Medicare PFS payment year technology to satisfy some of the CCM scope of service elements though it does not require the use of certified EHR technology for some of the services involving the care plan and clinical summaries. Code 99490 cannot be billed during the same service period of several other codes including codes G0181/G0182 relating to hospice care.