Chronic Care Management a simple Guide: Explanation, Primary Characteristics, and Billing Codes
Background:
The US population is growing at an exponential rate by 2030, it is expected to have 81.5 Medicare enrollments. In 2015, CMS started value-based care programs. They started off with Chronic Care Management (CCM) and with the success of it, they later expanded into Remote Patient Monitoring (RPM) in 2019. These services showed improved patient outcomes by showing a reduction in hospitalizations, readmissions, and ER visits. These services not only improved the patient’s outcomes but also added a new revenue stream for the physicians that too on a monthly basis.However, in recent years, a paradigm shift has occurred in the form of Chronic Care Management (CCM). CCM is a patient-centric approach that aims to provide comprehensive and proactive care for individuals with chronic diseases. It recognizes the need for continuous support, education, and coordination among healthcare providers, empowering patients to actively participate in their own care.
Chronic Care Management:
The In the Medicare framework, a “care management service” is an encompassed program enabling healthcare providers to efficiently coordinate patient care beyond conventional office consultations.
Chronic Care Management (CCM) is a comprehensive approach to managing chronic diseases that aims to improve patient outcomes, enhance care coordination, and empower individuals to take an active role in their own healthcare. With the rising prevalence of chronic conditions and the complex nature of managing these diseases, CCM has emerged as a transformative solution that addresses the unique challenges faced by both patients and healthcare providers.
Eligible Patients:
- Two or more chronic conditions
- Medicare Beneficiaries (Medicare Part B with both Medicare and Medicare Advantage plans)
Non-Eligible Patients:
- Home Health Care
- Skilled Nursing Care
- Hospitalized
Chronic Care Management Service Practitioners:
These physicians and Non-Physician Practitioners (NPPs) may bill CCM services:
- Physicians (Primary & Specialists)
- Certified Nurse Midwives (CNMs)
- Clinical Nurse Specialists (CNSs)
- Nurse Practitioners (NPs)
- Physician Assistants (PAs)
Patient Consent:
Written or Verbal, both the consents are acceptable by CMS. We should make sure to cover the following points during the consenting:
- CCM service availability
- Co-pay responsibility
- Only one physician can bill for the service in one calendar month.
- The patient has the right to stop service at any time.
Billing Codes for CCM:
|
CPT Code |
Description |
Reimbursement |
|
G0511 |
20mins (RHC and FHQC) |
$76 |
|
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 |
$62 |
|
99439 |
Chronic care management services, additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month |
$47 |
|
99491 |
Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month |
$83 |
|
99487 |
Complex chronic care management services, 60 minutes of Physician or other qualified health care professional time |
$132 |
|
99489 |
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month |
$70 |
Chronic Care Management Revenue:
With the estimated 100 active patients on CCM, a practice can make:
- $6200/month
- $74,400/year
