Chronic care management (CCM) services are typically non-face-to-face services provided to Medicare beneficiaries who have multiple 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. Patients who are eligible for CCM services benefit from additional resources to help them manage their health more effectively. More coordinated care can result in better outcomes as well as lower overall costs through reduced hospitalizations and emergency room visits. As the health care system transitions from a fee-for-service model to value-based payment, CCM makes it possible for medical providers to be reimbursed for the time and effort invested in caring for patients who have chronic conditions.
How Do We Bill For CCM?
There are four primary CPT codes used to report CCM services:
- 99490 - non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability.
- 99487 - Complex CCM is 60-minute timed services provided by clinical staff to substantially revise or establish a comprehensive care plan that involves moderate- to high-complexity medical decision making.
- 99489 - for each additional 30 minutes (cannot be billed with CPT code 99490)
- 99491 - CCM services provided personally by a physician or other qualified health care professional for 30 minutes.
Most CCM services do not require direct time by the physician but typically performed by support staff working under the physician’s license. Typical services that count under CCM include management of chronic conditions, referrals to other providers, prescription management, and general review of patient status. All of these services come standard with the Welby platform to help your staff automate this work.
There are two types of CCM, with the most typical being the non-complex kind and requires general oversight of a patient with two health conditions.
Non-complex CCM Requirements
- Two or more chronic conditions expected to last at least 12 months (or until the death of the patient)
- Patient consent (verbal or signed)
- Personalized care plan in a certified EHR and a copy provided to a patient
- 24/7 patient access to a member of the care team for urgent needs
- Enhanced non-face-to-face communication between patient and care team
- Management of care transitions
- At least 20 minutes of clinical staff time per calendar month spent on non-face-to-face CCM services directed by a physician or other qualified health care professional
- CCM services provided by a physician or other qualified health care professional requires at least 30 minutes of personal time spent in care management activities
Who Can Provide and Bill for CCM Services?
While services are provided by a clinical staff person, the service must be billed under one of the following:
- Clinical nurse specialist (CNS)
- Nurse practitioner (NP)
- Physician Assistant (PA)
- Certified nurse-midwife
Things for Your Practice to Consider When Getting Started
- Identify Medicare Part B patients with two or more chronic conditions who may be eligible.
- Start with patients that regularly call into the clinic to manage symptoms or with medical questions that may benefit from some automated solutions..
- Identify patients that may be most likely to benefit from care management based on the number of specialists involved in their care or who have limited social or local family support.
- Identify patients dually eligible for traditional Medicare and Medicaid.
- Identify the technology that will be needed to implement without the need for hiring additional staffing.
Welby Health offers solutions to help you practice get started in Chronic Care Management with off the shelf software solutions that can be implemented today and out of the box CCM reports to bill for Medicare. Request a free consultation to see how Welby can help your practice make the transition to a fee for value model and improve patient outcomes.