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Chronic Care Management (CCM) Benefits and Guidelines


Chronic care management (CCM) is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients.

CHRONIC CARE MANAGEMENT (CCM):

Medicare initially provided payment for CPT code 99490 beginning January 1, 2015 to separately identify and value clinical staff time and other resources used in providing CCM.

CMS adopted 3 additional billing codes (G0506, CPT 99487, CPT 99489)

The Centers for Medicare & Medicaid Services (CMS) recognizes CCM takes time and effort.

ELIGIBLE BENEFICIARIES:

Patient have two or more chronic conditions expected to last at least 12 months or until death, that place them at significant risk of death, acute exacerbation, or functional decline .

PATIENT CONSENT:

A practitioner must obtain patient consent before furnishing or billing CCM. Consent may be verbal or written but must be documented in the medical record, and includes informing them about:

The availability of CCM services and applicable cost-sharing

Only one practitioner may be paid for CCM services for a given calendar month. This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both)

The right to stop CCM services at any time (effective at the end of the calendar month)

ELIGIBLE REPORTING PRACTITIONERS:
  • Physicians
  • Physician Assistants,
  • Clinical Nurse Specialists,
  • Nurse Practitioners,
  • Certified Nurse Midwives
CPT CODES AND PAYMENT FOR CCM:
  1. CPT G0506 (Add -on code to CCM initiating visit ($64 )
  2. CPT 99490 Non complex CCM($43)
  3. CPT 99487 (Complex CCM 60 mins ($94)
  4. CPT +99489 (Complex CCM ) additional 30 mins ($47)
PATIENTS BENEFIT FROM CCM:
  • Spend more time focusing on health and help work towards your health and Quality of life goals
  • Don’t always have to come into the office to get help; you can also make a call.
  • Patients will receive a comprehensive care plan.
CCM SUPPORTS OUR PRACTICE:
  1. Improve care coordination.
  2. Improve patient satisfaction and compliance, and decrease hospitalization and emergency department visits.
  3. Increased payment to practice for the coordinated CCM services we provide outside of face to face visits
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