This resources was designed to support the compliance aspects of Chronic Care Management (CCM) services.  CCM has a number of complexities and compliance considerations that are reviewed on this site.   The number of practices offering CCM services has been steadily growing, however, compliance aspects have not always been in the  forefront.

Background:

Chronic Care Management Services

CCM services are non-face-to-face services furnished by a physicians and other qualified health practitioners and their clinical staff, for patients with two or more serious chronic conditions. As of 2020 there are 5 codes that may be billed for CCM services, divided into complex and noncomplex CCM services.  They have significant revenue potential and represent a viable option for practices that have reduced patient volumes.

The services may be provided by clinical staff members or providers.  When 30 minutes of CCM services are personally provided by a nurse practitioner or physician assistant, for example, they will be reimbursed approximately $85.90.  Conservatively, a mid-level provider could earn in excess of $50,000 a year in supplemental income through CCM by providing this service for 10 hours per week.

We have carefully reviewed the requirements for providing CCM services, which are built into CCMTrack, our low-cost software solution for CCM services.  We invite you to speak with our staff and lead physician developer and compliance officer.  Please contact us at [INSERT CONTACT INFO]

CCM Summary

The following information has been updated to reflect changes in the Medicare 2020 Physician Fee Schedule.

Table 1. Chronic Care Management Codes (CY 2020)

Non-Complex CCM Services
CPT Code	Summary	Payment
99490 (“Non-Complex CCM”)	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional (QHP), per calendar month	$43.18
G2058*	Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	$38.85
99491 (“Non-Complex CCM”)	Chronic care management services, provided personally by a physician or other QHP, at least 30 minutes of physician or other QHP time, per calendar month	$85.90
G0506	Comprehensive assessment of and care planning for patients requiring chronic care management services	$47.45
Complex CCM Services
CPT Code	Summary
99487 Complex CCM	Complex chronic care management services, first 60 minutes of clinical staff time with moderate or high complexity medical decision-making by the reporting practitioner	$95.01
99489 Complex CCM	Complex chronic care management services, each additional 30 minutes of clinical staff time with moderate or high complexity medical decision-making by the reporting practitioner	$46.01

*New for 2020

CCM services have expanded significantly from 2015 when they were limited to a single CPT code: 99490.  CMS states that CCM services remain underutilized and have continued to enhance the revenue potential of this initiative.

In order to qualify for CCM services patients need to have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk  of death, acute exacerbation/ decompensation, or functional decline.  CMS estimates that approximately 66% of all Medicare patients have two or more chronic conditions.  Examples include hypertension, diabetes, minimal brain dysfunction, osteoarthritis and many other conditions.

Practices must maintain a comprehensive care plan when reporting noncomplex or complex CCM services. However complex CCM services require “establishment or substantial revision of the conference of care plan.”  Medicare clarified the meaning of this component in the 2020 Physician Fee Schedule (PFS)Final rule, stating that this would be interpreted as a comprehensive care plan is established, implemented, revised, or monitored, which is consistent with the noncomplex CCM requirement.

CMS updated the requirements for the comprehensive care plan in the 2020 PFS Final Rule.  They stated “The comprehensive care plan for all health issues typically includes, but is not limited to, the following elements:

• Problem list.
• Expected outcome and prognosis.
• Measurable treatment goals.
• Cognitive and functional assessment.
• Symptom management
• Planned interventions.
• Medical management.
• Environmental evaluation
• Caregiver assessment
• Interaction and coordination with outside resources and practitioners and providers.
• Requirements for periodic review.
• When applicable, revision of the care plan.’’

CCM has additional requirements, as detailed in table 2.  We have address all of these items in CCMTrack.  Please contact us for further information [INSERT CONTACT INFORMATION HERE]

Table 2: Chronic Care Management Services Summary

CCM Services Summary

Verbal Consent Informed regarding availability of the service; that only one practitioner can bill per month; the right to stop services effective at the end of any service period; and the cost-sharing applies (if no supplemental insurance). Document that consent was obtained

Initiating Visit for New Patients (separately paid)

Certified Electronic Health Record (EHR) Use Structured Recording of Core Patient Information Using Certified EHR (demographics, problem list, medications, allergies).

24/7 Access (“On-Call” Service)

Designated Care Team Member

Comprehensive Care Management Systematic needs assessment (medical and psychosocial). Ensure receipt of preventive services. Medication reconciliation, management and oversight of self-management.

Comprehensive Electric Care Plan Plan is available timely within and outside the practice (can include facts). Copy of care plan to patient/caregiver (format not prescribed). Establish, implement, revise or monitor the plan.

Management of Care Transitions/Referrals (e.g., discharges, ED visit follow-up, referrals) Create/exchange continuity of care document(s) timely (format not prescribed).

Home-and Community-based Care Coordination Coordinate with any home-and community-based clinical service providers, and document communication with them regarding psychosocial needs and functional deficits.

Enhanced Communication Opportunities Offer asynchronous non-face-to-face methods other than telephone, such as secure email

*All elements that are medically reasonable and necessary must be furnished during the month, but all elements do not necessarily apply every month. Consent only needs to be obtained once, initiating visits are only for new patients or patients not seen within a year prior to initiation of CCM.

This information was taken from the 2020 Physician Fee Schedule Final Rule.  A reader friendly version of the CCM section of this document is available here.

This site is sponsored by Apollo HIT, LLC, a healthcare IT and compliance consulting company.  Please contact us at Michael@ApolloHIT.com or visit our website at www.ApolloHIT.com.