Chronic Care Management Gets an Upgrade in 2017

In July 2015, the Centers for Medicare and Medicaid Services update-1672356_1920(CMS) approved the use of the CPT code 99490, Chronic Care Management (CCM), for reimbursement along with a host of necessary requirements. The CCM program was designed to decrease the overall cost for Medicare patients who have two or more chronic conditions while improving the quality of life and outcomes for the patient.

Although the program was not implemented in a large percentage of the nation, CMS has already begun to see the benefits for patients who are actively enrolled in CCM programs.  On November 2, 2016, CMS announced that due to the positive results they would be expanding this program significantly.

Ease of Burden

A host of changes were made to simplify the eligibility/enrollment requirements for CCM patients. Most notable of which:

  • The initiating face-to-face requirement for CCM patients to enroll is no longer required unless the patient is new or has not been seen by the physician in the last 12 months.
  • The requirement to have after-hours access to the electronic care plan has been removed.
  • Patients are now permitted to enroll with verbal consent provided it is documented in the patient’s chart.
  • Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) are now permitted to work with third-party service providers to provide CCM services under general supervision regulations.

Initiating Visit Add-On

Now that the face-to-face visit is no longer required to initiate CCM services, the discussion of CCM along with care planning prior to enrollment at a face-to-face Evaluation & Management (E&M) is now considered an add-on service.  Physicians and certain NPP’s can now bill G0506 as an add-on payment to the base E&M CPT code.

Complex CCM

For certain CCM patients, 20 minutes per month is insufficient to manage their conditions and help them excel into a better quality of life and improved outcomes.  CMS recognized this issue and approved two additional CCM Codes:

  • 99487 Complex Chronic Care Management – 60 minutes per calendar month
    • Cannot be billed in the same time-period as 99490
    • FQHCs and RHCs cannot bill this code
  • 99489 Complex Chronic Care Management Add-On – 30 minutes additional per calendar month
    • Add-on code to 99487 only
    • Cannot be billed for less than 30 minutes
    • Cannot be billed with 99490
    • FQHCs and RHCs cannot bill this code

If you have questions about Chronic Care Management our team of specialists can help.  Contact Us to learn more.

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