Maximize Revenue for CCM Providers

Maximize Revenue for CCM Providers

Part 1: Understand payable services for billing chronic care management.

The Centers for Medicare & Medicaid Services (CMS) recognizes chronic care management (CCM) as a critical component of primary care that contributes to better health. Although primary care practitioners may bill CCM most frequently, specialty practitioners may provide and bill CCM, in certain circumstances.

CCM Guidelines Have Evolved

In 2015, CMS began paying separately for CCM services furnished to Medicare patients with multiple chronic conditions. Since then, the requirements for providing such services have changed drastically (Medicare Learning Network, Chronic Care Management Services, 2016). Today, the 2017 CCM codes (CPT® 99487, 99489, 99490) are assigned general supervision, indicating the service does not have to be personally performed by the billing practitioner due to the overall direction and control they provide.

99487
Chronic care management services, 60-89 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

+99489
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

99490
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

The patient must be established and seen within the last year. If the patient is new or has not been seen within the last year, CMS requires a face-to-face visit to occur; however, a practitioner who personally performs a CCM care plan (with an extensive assessment) also may bill HCPCS Level II code G0506 Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services at the time of service. G0506 is billed separately from monthly care management services and is considered an add-on code (listed separately, in addition to the primary procedure).

Take Cost-sharing Precautions

Patient cost sharing applies to CCM services; having the patient’s consent will ensure that the patient is engaged and aware of costs upfront. Obtaining consent also may lessen duplicate billing. Patient consent may be obtained in writing or verbally; however, the consent must be documented in the patient’s medical record.

CCM services code CPT® 99490 requires the patient to have:

  • Multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient;
  • Chronic conditions that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline; and
  • A comprehensive care plan established, implemented, revised, or monitored.

CCM services of fewer than 20 minutes duration, in a month, are not reported separately.

Complex CCM services code 99487 requires coordination of specialties and services, inability to perform activities of daily living and/or cognitive impairment, psychiatric and other medical comorbidities, social support requirements, or difficulty with access to care. The patient must have:

  • Multiple (two or more) chronic conditions expected to last at least 12 months or until death;
  • Chronic conditions that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline;
  • Established or substantial revision of a comprehensive care plan;
  • Medical decision-making of moderate or high complexity; and
  • 60 minutes of clinical staff time directed by a physician or other qualified healthcare professionals, per month.

Complex CCM services of less than 60 minutes duration, in a month, are not reported separately.

CPT® 99489 is an add-on code used to report each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per month. List this code separately in addition to the primary procedure, 99487.

Silvermoon Taggart

Silvermoon Whitewater Taggart, MBA, CPC, AAPC Fellow is Practice Administrator at Pulmonary and Internal Medicine Associates, Inc., a nine provider practice in Stuart, Fla.

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Silvermoon Whitewater Taggart, MBA, CPC, AAPC Fellow is Practice Administrator at Pulmonary and Internal Medicine Associates, Inc., a nine provider practice in Stuart, Fla.

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