Chronic Care Management (CCM)
Chronic Care Management (CCM) is a service that the Centers for Medicare & Medicaid Services (CMS) released in 2015. The program allows providers who accept Medicare patients to get paid for managing chronic conditions for patients in a non face-to-face setting.
Managing chronic conditions is a time-consuming process, and the responsibility for coordinating care often falls on the shoulders of busy primary care physicians (PCPs). CCM can help PCPs to manage patients’ chronic conditions more effectively, improve communication among other treating clinicians, and provide a way to optimize revenue for your practice.
CCM services are designed to support PCP efforts by allowing them to spend less time coordinating referrals and refilling prescriptions, which can contribute towards the required time to bill CCM services.
Chronic Care Management Workflow
Enroll patients in CCM services
Treat chronic conditions
Get reimbursed
Why Chronic Care Management is Important
The CCM program aims to reduce emergency room visits and hospitalization, increase patient engagement in their own healthcare, enhance communication between care team members, and provide access to necessary medical resources.
CCM benefits the patient and provider by improving patient satisfaction, increasing revenue, and strengthening care coordination in the medical community, which many patients cannot do without the intervention of a physician.
Which providers are qualified to participate in CCM?
✓ Physicians
✓ Clinical nurse specialists (CNS)
✓ Nurse practitioners (NP)
✓ Physician assistants (PA)
✓ Certified nurse midwives
Although there will be multiple clinical staff working with a patient, only one billing provider is able to bill for the CCM services.
How does CCM bring in revenue?
CCM is perfect for most providers and offers a great new revenue stream for participating practices. With more than 67 million Americans enrolled in Medicare or Medicare Advantage plans, and an average reimbursement of $40 per patient per month, Medicare provides coverage for practitioners to bill CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM activities in a month, with the ability to then bill 99439 for the second and third 20-minute increments. In 2021, the payment for CPT 99490 was $42.23; each add-on CPT code pays $37.89 and can be reported up to two times. The total reimbursement for at least an hour of non-complex CCM services is $118.01, which can make adding CCM services a significant boon for patients and practices.
Chronic Care Management CPT Codes
99490 – Non-complex Chronic Care Evaluation and Management Services
20-minute timed service for patients with two or more chronic conditions provided by clinical staff to coordinate care across providers and support patient accountability. May be billed once per calendar month.
99439 – Additional Non-complex Chronic Care Evaluation and Management Services
Each additional 20-minutes of clinical staff time providing non-complex CCM services (billed in conjunction with CPT code 99490)
99487 – Complex Chronic Care Evaluation and Management Services
60-minute timed service for patients with two or more chronic conditions provided by clinical staff to substantially revise or establish a comprehensive care plan that involves moderate-to- high complexity medical decision making. May be billed once per calendar month.
99489 – Additional Complex Chronic Care Evaluation and Management Services
Each additional 30-minutes of clinical staff time providing complex CCM services (billing in conjunction with CPT code 99490)
99491 – Complex Chronic Care Evaluation and Management Services
30-minutes of CCM services personally provided by a physician or other qualified health care professional
Getting started with the CCM program
1.) Run report of Medicare patient count with 2+ chronic conditions
2.) Get an EHR system if you don’t have one
3.) Consider hiring additional staff
4.) Train your billers
5.) Update your EHR documentation templates, including customizing a comprehensive care plan template
6.) Develop a risk stratification scoring system
7.) Revise your schedule
8.) Train your office staff
Chronic Care Management Requirements
Documentation
CCM services are required to be documented in an electronic health record (EHR) system. Some services that are covered by CCM include:
-
- Chronic condition management
- Referral management
- Prescription management
- Ongoing patient status review
Billing for Non-complex CCM (99490)
- 2+ chronic conditions expected to last more than 12 months
- Patient consent (verbal or signed)
- Personalized care plan in a certified EHR and a copy provided to the patient
- 24/7 access to a member of the care team for urgent needs
- Management of care transitions
- Minimum 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
Billing for Complex CCM (99487)
- All the requirements for billing CPT code 99490 except a minimum of 60 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
- Medical decision-making complexity moderate-to-high
Comprehensive Care Plan
A comprehensive care plan for any health issues usually includes at least:
- Problem list
- Measurable treatment goals
- Expected outcome and prognosis
- Cognitive and functional assessment
- Symptom management
- Planned interventions
- Environmental evaluation
- Medication management
- Caregiver assessment
- Interaction and coordination with outside resources, practitioners, and providers
- Periodic review
- Revision, if needed
