Chronic Care Management
What is Chronic Care Management(CCM)?
CCM is a Medicare reimbursement program for managing care for beneficiaries with multiple chronic conditions. Medicare Fee for Service beneficiaries with 2+ chronic conditions expected to last at least 12 months are eligible. It includes CPT 99490 – a monthly reimbursement for 20 minutes of clinical staff time spent on non-face-to-face care coordination per patient. The non face-to-face time can be provided by any clinical staff members, including external care managers.
Stand alone service are included as part of RPM Plus CCM patients.
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◾ More accessible care – More access to their primary care provider. A monthly communication and review of health that ensures medication adherence and monitoring.
◾ More immediate care – Communicate changes in health status directly to the medical provider. Provides access to medical records and provides shared decision making between both the patient and the provider. Provides a dynamic care plan that is up-to-date and relevant to the patient condition.
◾ Promotes coordinated and comprehensive care while individualizing patient-centered care plans.
◾ Reduces crisis-like care through ongoing communication and proactive disease management.
◾ Promotes coordinated and comprehensive care outside of the clinical setting.
◾ Increases monthly reimbursement
Allows for outsourcing and reduces the need for :
◾ Staff training and time away from demands of the practice
◾ Billing and reimbursement coding and knowledge
◾ Hiring designated care coordinators
◾ Budgeting for specialized staff and technology to meet the requirements of CCM
◾ An inability to manage an unpredictable variation in patient volume
CCM CPT Codes:
◾ 2017 – relaxed service elements & billing requirements
◾ 20 minutes / month
◾ Complex CCM
◾ 29487 – 60 minutes/month
◾ $94.68 (national)
◾ 29489 – add on – 30 minutes / month (after 1st60)
◾ $47.16 / $26.56
CCM Initiating visit – G0506
◾ Add-on – face-to-face
What Activities Count Towards CCM Time?
Any non-face-to-face care management and coordination service provided on behalf of an enrolled beneficiary by a clinical staff member or provider counts.
◾ Phone calls, emails and messaging with the patient and caregiver (+10 minutes)
◾ Lab, report, and image review (+5 minutes)
◾ Care plan creation, revision, and review (+20 minutes)
◾ Chart documentation
◾ Referring to and consulting with other providers, reviewing consult notes (+10 minutes)
◾ Communicating with home/community providers
◾ Post-discharge follow-up
◾ Medication refills and medication reconciliation (+5 minutes)
◾ Drug and other prior authorizations (+10 minutes)