Chronic Care Management Solutions

Chronic care management services refer to services that are not provided in person, but rather are offered to Medicare beneficiaries with at least two chronic conditions that are expected to last for a minimum of 12 months or until the patient’s death.

The Centers for Medicare & Medicaid Services (CMS) acknowledges the importance of CCM services as fundamental elements of primary care that enhance wellness and lower healthcare expenditures.

Implementing Medicare Chronic Care Management services can provide several benefits for both patients and healthcare providers. Some reasons why Medicare CCM may be beneficial include:

1. Improved patient outcomes CCM services are designed to help patients manage their chronic conditions and promote better health outcomes. By providing regular check-ins, care coordination, and support, CCM services can help patients avoid complications, reduce hospitalizations, and improve their overall quality of life.
2. Increased revenue for healthcare providers: By providing CCM services, eligible healthcare providers can receive reimbursement from Medicare, which can help increase their revenue streams. Additionally, providing CCM services can help improve patient satisfaction and loyalty, leading to increased business for the healthcare provider.
3. Reduced healthcare costs: By helping patients better manage their chronic conditions, CCM services can help reduce healthcare costs associated with hospitalizations, emergency department visits, and other expensive treatments. This can help lower overall healthcare expenditures for both patients and payers.

These physicians and Non-Physician Practitioners (NPPs) may bill CCM services:

• Physicians
• Certified Nurse Midwives (CNMs)
• Clinical Nurse Specialists (CNSs)
• Nurse Practitioners (NPs)
• Physician Assistants (PAs)

They must also have an established relationship with the patient and must use an electronic health record (EHR) system that meets certain requirements to document and report the CCM services. Take note of the different codes used for billing between NPPs and physicians.

CPT code 99491: Time only the billing practitioner spends. Clinical staff NPPs’ time doesn’t count.

CPT codes 99487, 99489, and 99490: Time spent directly by NPPs. Practitioner time is also allowed if not billed under 99491 already.

Medicare reimburses for Chronic Care Management (CCM) services on a monthly basis, meaning that eligible healthcare providers can receive payment for each month that they provide CCM services to an eligible patient. It’s important to note that Medicare may also reimburse for additional services provided in conjunction with CCM, such as transitional care management, advance care planning, and annual wellness visits, among others. However, the reimbursement rates for these services may differ from that of CCM services. The rates below are based on national averages.

The CPT codes used to report CCM services are:

• CPT code 99437 $49.98
  30 additional minutes of provider time (no limit)
• CPT code 99439 ($47.44)
  Each additional 20 minutes of clinical staff time spent providing non-complex CCM directed by a physician or other qualified health care professional (billed in conjunction with CPT code99490)
• CPT code 99490 ($62,69)
  Non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability.
• CPT code 99491 $85.06
  CCM services are provided personally by a physician or other qualified health care professional for at least 30 minutes.
• CPT code 99487 $133.18
  Complex CCM is a 60-minute timed service provided by clinical staff to substantially revise or establish comprehensive care plan that involves moderate- to high-complexity medical decision-making.
• CPT code 99489 $70.49
  Is each additional 30 minutes of clinical staff time spent providing complex CCM directed by a physician or other qualified health care professional (report in conjunction with CPT code 99487; cannot be billed with CPT code 99490)