Chronic Care Management Program

How Can We Help

It has never been more important to improve your patients’ outcomes. There are a lot of questions about Chronic Care Management (CCM) implementation including required elements, billing, software, staff, outsourcing and more. Dr. Koyfman has been consulting large and small companies on Chronic Care Management (CCM). Click here to schedule introduction call @ https://calendly.com/dr_irina/30min

What is Chronic Care Management (CCM)

Chronic Care Management (CCM) is a Medicare program that offers significant monthly reimbursement for the time providers and their staff spend helping patients between office visits.

Required Elements of CMS compliant CCM program

Multiple requirements exist to bill CCM. The requirements are complex and address patient’s eligibility, provider eligibility and billing components.

One must manage care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and followup after discharges from hospitals, skilled nursing facilities, or other health care facilities.

Care manager must also coordinate and communicate with home- and community-based clinical service providers. Furthermore, CMS states that care management for chronic conditions including systematic assessment of the patient’s medical, functional, and psychosocial needs; system-based approaches to ensure timely receipt of all recommended preventive care services; medication reconciliation with review of adherence and potential interactions; and oversight of patient self-management of medications

Benefits

CCM, done right, is the best way to increase your practice revenue along with patients’ satisfaction. A health care provider who can enroll 500 CCM patients can generate an add additional $20,000+ per month or $250,000+ per year of revenue.

Chronic Care Management Billing Codes

Chronic Care Management is billed using Current Procedural Terminology (CPT) codes. Specified codes determine and categorize treatment procedures, care services, and billing rates.

Code	Description	Summary Requirements	Payment Average
HCPCS G0506	Comprehensive Assessment & Care Planning	Patient enrolled in CCM Systematic assessment & care planning personally performed by the billing provider Add-on code to the standard E&M code (99212-99215), AWV or IPPE initiating visit	$62
CPT 99490	Standard CCM	Min of 20 minutes of care management outside of office visits performed by clinical staff	$64 (increased from $41)
CPT 99439 (New in 2021)	Non-complex Add on x 2	Additional 20 minutes of “non-complex” CCM Reportable up to 2x per month (after 99490)	$47 (increased from $38)
CPT 99487	Complex CCM	60+ minutes of care management outside office visits	$130 (increased from $92)
CPT 99489	Complex Add on	Billed incrementally for each additional 30 minutes spent beyond the first 60 minutes for Complex CCM case	$68 (increased from $44)
CPT 99491	Provider preforming CCM	30+ minutes of care management outside of office visits Provided personally by a physician or other qualified healthcare professional	$83 (increased from $82)
CPT 99437 (New in 2022)	Provider preforming CCM Add On	Additional 30 minutes of care management outside of office visits	$59

 

Chronic Care Management services and CPT 99490

CPT 99490 describes activities that are not typically or ordinarily furnished face-to-face, such as telephone communication, review of medical records and test results, and consultation and exchange of health information with other providers.

Activities that are appropriate for CCM are (not all inclusive list):

Chronic Care Management (CCM) and Principal Care Management (PCM)

CCM is the program for people with 2 or more chronic conditions, however 6 in 10 Americans have at least 1 chronic condition. PCM mimics CCM, however there are some notably difference you should know about.

Chronic Care Management intended for	Principal Care Management intended for
People with 2+ chronic conditions	People with only 1 chronic condition
Mostly for Primary Care Providers	Mostly for Specialists
Requires Comprehensive Care Plan	Disease specific Care Plan
Minimum billing is 20 minutes (CPT 99490)	Minimum billing is 30 minutes (99424/5)

How Can We Help

It has never been more important to improve your patients’ outcomes. There are a lot of questions about Chronic Care Management (CCM) implementation including required elements, billing, software, staff, outsourcing and more. Dr. Koyfman has been consulting large and small companies on Chronic Care Management (CCM). Click here to schedule introduction call @ https://calendly.com/dr_irina/30min