Chronic Care Management (CCM) was introduced in 2015 as a separately paid service under the Medicare Fee Schedule. It was designed to compensate practitioners for the in-between care they were already providing outside of office visits for patients, but couldn’t bill for. CCM has since allowed practitioners to provide more efficient care for their patients with chronic conditions. In this guide, we’ll explain everything you need to know about Chronic Care Management, from the eligibility requirements to how practitioners can bill Medicare for their services.
What Is Chronic Care Management?
Chronic Care Management (CCM) is a Medicare Part B program that allows healthcare providers to bill Medicare for the time and resources spent managing a patient’s chronic condition. It covers all the services a patient’s primary care team provides in between visits, such as developing a care plan, recording patient health information, managing their medications, and coordinating care between providers.
At least 20 minutes or more of CCM services can be billed per month. However, the patient must have two or more chronic conditions in order for the primary care team to be eligible for reimbursement.
Why Is CCM Important?
The Chronic Care Management program is designed to improve the quality of life for both patients and practitioners.
- Patients receive access to important medical resources, more efficient communication with their primary care team, and ongoing support that allows the patients to be more engaged in their own care.
- Practitioners can be reimbursed for the care provided in-between office visits known as “in-between visit care”. Both the practitioner’s time and their clinical staff time spent on these services are now billable through CCM. These are services already provided but typically not considered billable, such as managing patient medications, reviewing and explaining test results, coordinating care between providers, answering patient questions, and offering health education.
- CCM improves patient-practitioner relationships, which increases patient satisfaction and compliance, and also increases revenue for the healthcare provider.
Key Takeaway: Transform Non-Revenue Tasks into Profit with CCM
In a physician’s office, the main revenue comes from the physician’s work. To increase revenue, you need more physicians and more office visits. One huge benefit of running Chronic Care Management (CCM) is that it turns non-revenue-generating tasks and staff into revenue-generating ones. With CCM services, an employee earning $20-$35 per hour can generate over $120 per hour for the office.
Which Conditions Qualify for Chronic Care Management?
As we mentioned earlier, eligible CCM patients must have two or more chronic conditions. According to the Centers for Medicare and Medicaid Services (CMS), chronic conditions must be expected to last at least one year, or until the patient’s death. Conditions that put the patient “at significant risk of death, acute exacerbation and/or decompensation, or functional decline” also qualify.
Eligible chronic conditions include, but are not limited to:
- Alzheimer’s disease
- Arthritis
- Asthma
- Autism spectrum disorders
- Cancer
- Cardiovascular disease
- Chronic Obstructive Pulmonary Disease (COPD)
- Depression
- Diabetes
- Glaucoma
- Hypertension
- HIV/AIDS
- Osteoporosis
How Does Billing for CCM Work?
One of the biggest questions practitioners have about Chronic Care Management is how to bill for it. Billing for CCM involves using specific codes to ensure proper reimbursement. Practitioners may submit their claim at the end of the service period (one calendar month), or after completing the minimum required billable time.
ValueCare Suite software solution takes the guesswork out of structuring your billing codes. Your team documents each care performed, and we categorize the codes and generate a billing report accordingly.
Basic “Non-Complex” CCM Codes
Practitioners can bill for basic CCM using the following codes: (CPT codes 99490 and 99439 are the most common and frequently used in Chronic Care Management (CCM).)
- CPT 99490: A minimum of 20 minutes of non-complex CCM services provided by the provider’s clinical staff under the direction of a physician or other qualified healthcare professional. The maximum billable amount per month is 1 unit.
- CPT 99439: This add-on code is used alongside CPT 99490 for each additional 20 minutes of non-complex CCM services provided by the provider’s clinical staff under the direction of a physician or other qualified healthcare professional. It is billed after the requirements for CPT 99490 have been met. The maximum billable amount per month is 2 units.
- CPT 99491: A minimum of 30 minutes of non-complex CCM services provided personally by the billing physician or other qualified healthcare professional per calendar month. The maximum billable amount per month is 1 unit.
- CPT 99437: This add-on code is used alongside CPT 99491 for each additional 30 minutes of CCM services provided by a physician or other qualified healthcare professional. It is billed after the requirements for CPT 99491 have been met. The maximum billable amount per month is 2 units.
Complex CCM Codes
Billing for complex Chronic Care Management involves the following codes:
- CPT 99487: This code is used for complex CCM services totaling at least 60 minutes of clinical staff time per calendar month, that were directed by a physician or other qualified healthcare professional.
- CPT 99489: This add-on code is used with CPT 99487 for each additional 30 minutes of complex CCM services provided by clinical staff per calendar month, under the direction of a physician or other qualified healthcare professional. It is billed after the requirements for CPT 99487 have been met. This code covers each additional 30 minutes of complex CCM services provided per calendar month.
While physicians, physician assistants, nurse practitioners, certified nurse midwives, and clinical nurse specialists can all bill for CCM, only one practitioner can receive reimbursement per patient each calendar month. The practitioner can report either non-complex or complex CCM services for each patient per calendar month, but not both.
As of 2024, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill for CCM using code HCPCS G0511 as well as Transitional Care Management (TCM) services for a single patient in the same calendar month.
Grow an Effective CCM Program with ValueCare Suite
An effective Chronic Care Management program will lead to better patient satisfaction and higher revenue for their healthcare provider. But keeping track of billable CCM services can be challenging. At ValueCare Suite, we take the guesswork out of implementing successful CCM programs. Our user-friendly software streamlines your CMS workflows and helps you turn activities like phone calls with patients and physician collaboration into billable time. Book a demo today to learn more.
Images used under creative commons license – commercial use (5/20/2024). Image by freepik
