CCM Frequently Asked Questions
Examples of chronic conditions include, but are not limited to, the following:
- Alzheimer’s disease and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer
- Cardiovascular Disease
- Chronic Obstructive Pulmonary Disease
- Depression
- Diabetes
- Hypertension
- Infectious diseases such as HIV/AIDS
Activities that count towards CCM include:
- Phone calls and patient questions
- Medication refills and adjustments
- Scheduling, referrals, and prior authorizations
- Care planning and care coordination
- CPT 99490 – Chronic Care Management Services
- HCPCS G0511 – General Care Management Services (for FQHCs/RHCs)
- HCPCS G0506 – Comprehensive Assessment & Care Planning
- CPT 99439 – non-complex CCM Add-on (New in 2021. Previously G2058)
- CPT 99487 – Complex Chronic Care Management Services
- CPT 99489 – Complex CCM Add-on
- CPT 99491 – Physician-provided CCM
Clinical staff will provide CCM services incident to the services of the billing physician (or other appropriate practitioner who can be a physician assistant, nurse practitioner, clinical nurse specialist or certified nurse midwife). Time spent by clinical staff may only be counted if Medicare’s “incident to” rules are met such as supervision, applicable State law, licensure and scope of practice. If the billing physician (or other appropriate billing practitioner) provides CCM services directly, that time counts towards the 20 minute minimum time. Of course, other staff may help facilitate CCM services, but only time spent by clinical staff may be counted towards the 20 minute minimum time.
CPT defines a clinical staff member as “a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service; but who does not individually report that professional service.”
The Centers for Medicare and Medicaid Services (CMS) provided an exception under Medicare’s incident to rules that permits clinical staff to provide the CCM service incident to the services of the billing physician/practitioner under the general supervision (rather than direct supervision) of a physician/practitioner. “General supervision” means the service is furnished under the billing physician/practitioner’s overall direction and control, but that person could be on call and not necessarily on site in the office.