Medicare recently published a proposed Physician Fee Schedule for 2017 and there are a number of changes proposed for the CCM program that, if approved, will go into effect on January 1, 2017:

  • Starting in January 2017, Medicare proposes that the CCM patients can be initiated via a phone call with documentation of consent. Initiating CCM currently requires a face-to-face visit during which the program is explained to the patient and where written consent is obtained.  This has been a barrier to adoption
    • Exceptions to the new proposed enrollment process are new patients or patients not seen within the past year.  These patients will still require a face-to-face visit.
  • Beneficiary consent can be obtained over the phone or in person without a written agreement.  The patient’s consent will need to be documented in the medical record.
  • CCM providers not longer have to make the Comprehensive Care Plan available to others involved with the patient’s care on a 24/7 basis.
  • Faxing the Comprehensive Care Plan will now be allowed.
  • Two new codes have been proposed:
    1.   99487:  60 minutes of clinical staff time per month
    2.   99489: 30 minutes of additional clinical staff time per month
  • A new G-code will pay for time spent by providers creating Comprehensive Care Plans

Impact:  This will remove several of the barriers to CCM, with the greatest impacts being an easing of the patient enrollment process and greater compensation for patients that require more than 60 minutes of non-face-to-face care each month.

For further information see the following section (and related sections) of the Medicare Proposed Rule for the 2017 Physician Fee Schedule in the Federal Register: “Reducing Administrative Burden and Improving Payment Accuracy for Chronic Care Management (CCM) Services”