Who needs an initiating visit before starting Chronic Care management?

[davidinasheville]

I see that an initiating visit is needed for certain patients before starting CCM (see Medicare statement below). It seems to me that the initiating visit is needed only for new patients or those not seen within the last year. Others in my practice interpret this as requiring an initiating visit for all patients (which was the rule until a few years ago). Can anyone clarify? If recently seen patients do not need an initiating visit, what should be the process for starting CCM service.? Can anyone share their protocol for this?

From Medicare May 2024: Initiating Visit. Before CCM services can start, we require an initiating visit for new patients or patients who the billing practitioner hasn’t seen within the previous 1 year. The initiating visit can happen during a comprehensive face-to-face evaluation and management (E/M) visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE). If the practitioner doesn’t discuss CCM during an E/M visit, AWV, or IPPE, it can’t count as the initiating visit. A face-to-face initiating visit isn’t part of CCM and can be separately billed. Practitioners who personally provide extensive assessment and care planning outside the usual effort described by the initiating visit and CCM codes may also bill HCPCS code G0506 once, as part of an initiating visit.

Thanks

David Clements

 

[rthomas@impcna.com]

I see that an initiating visit is needed for certain patients before starting CCM (see Medicare statement below). It seems to me that the initiating visit is needed only for new patients or those not seen within the last year. Others in my practice interpret this as requiring an initiating visit for all patients (which was the rule until a few years ago). Can anyone clarify? If recently seen patients do not need an initiating visit, what should be the process for starting CCM service.? Can anyone share their protocol for this?

From Medicare May 2024: Initiating Visit. Before CCM services can start, we require an initiating visit for new patients or patients who the billing practitioner hasn’t seen within the previous 1 year. The initiating visit can happen during a comprehensive face-to-face evaluation and management (E/M) visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE). If the practitioner doesn’t discuss CCM during an E/M visit, AWV, or IPPE, it can’t count as the initiating visit. A face-to-face initiating visit isn’t part of CCM and can be separately billed. Practitioners who personally provide extensive assessment and care planning outside the usual effort described by the initiating visit and CCM codes may also bill HCPCS code G0506 once, as part of an initiating visit.

Thanks

David Clements

The CCM initiation needs to be done by the provider (MD, DO, NP, PA) that will be providing CCM services. Our providers do this during the patient's chronic disease appt or AWE.

 

[jsmith@premiergeriatric.com]

was this ever answered? My understanding is CMS requires an initiating visit when the patient is new or has not been seen by the billing practitioner within the previous year. CMS guidance does not identify an additional initiating visit requirement for patients who have already been seen by the billing practitioner within the prior year

 

[Cynthia Hughes]

When reporting time-based chronic care management, the current Medicare guidance is as follows. (https://www.cms.gov/outreach-and-ed.../mlnproducts/mln-publications-items/icn909188)
an initiating visit for new patients or patients who you haven’t seen within the previous 1 year. Conduct the initiating visit during a comprehensive face-to-face evaluation and management (E/M) visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE).
If you don’t discuss CCM during an E/M visit, AWV, or IPPE, it can’t count as the initiating visit. A face-to-face initiating visit isn’t part of CCM and can be separately billed.
If you personally provide extensive assessment and care planning outside the usual effort described by the initiating visit and CCM codes, you may also bill HCPCS code G0506 once, as part of an initiating visit.

However, you may also want to review information from Medicare is in regard to the APCM services (https://www.cms.gov/medicare/paymen...ule/advanced-primary-care-management-services) that allows for care management services based on a patient's health conditions without time requirements.
Conduct an initiating visit (paid separately) for new patients. You don’t need to conduct this visit if you or another provider in your practice have:

• Seen the patient within the past 3 years
• Provided another care management service (APCM, CCM, or PCM) to the patient within the past year

The Medicare Annual Wellness Visit (AWV) may qualify as the initiating visit if the provider that will be responsible for providing APCM care performs the AWV.

Hope this is helpful.
Cindy