CCM is a comprehensive approach to manage chronic health conditions like Hypertension, Diabetes, Heart Failure to improve a patient’s clinical outcomes and reduce healthcare costs across the patient population.
As per CMS guidelines, qualifying patients for Medicare must have “two or more chronic conditions anticipated to endure for a minimum of 12 months or until the patient’s death, with these conditions posing a substantial risk of death, acute exacerbation, decompensation, or functional decline.”
Non-complex CCM, a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability.
Complex CCM, a 60-minute timed service provided by clinical staff to substantially revise or establish a comprehensive care plan that involves moderate- to high-complexity medical decision-making.
Each additional 30 minutes of clinical staff time spent providing complex CCM, directed by a physician or other qualified healthcare professional. This is reported in conjunction with CPT code 99487 and cannot be billed with CPT code 99490.
CCM services provided personally by a physician or other qualified healthcare professional for at least 30 minutes.
CCM is a Medicare program aimed at providing ongoing treatment between regular patient appointments. It includes services such as monthly clinical reviews, phone calls, physician reviews, referrals, prescription refills, and appointment scheduling. To qualify, patients must have two or more chronic conditions expected to last at least 12 months or until the patient’s death. These conditions should pose a significant risk of death, acute decompensation, or functional decline.
Patients are eligible for CCM if they have multiple (two or more) chronic conditions that are expected to last at least 12 months or until the patient’s death. These conditions should significantly risk the patient’s life or cause acute exacerbation or functional decline.
CCM services include creating and maintaining a comprehensive care plan for each eligible patient. This care plan covers the patient’s health history, medications, service providers, and other health needs. CCM also involves coordinating care between pharmacy, specialists, and other clinics, managing referrals, and providing 24/7 access to care.
Billing for CCM involves specific CPT codes based on the service duration and complexity. For example, CPT 99490 is used for services of at least 20 minutes per month, with an average reimbursement rate of $61.16. Add-on codes like CPT 99439 (each additional 20 minutes) also apply, with a reimbursement rate of $46.28.
To bill for CCM services, clinics need to verify CMS requirements for each patient monthly in terms of services provided, submit claims to CMS monthly, send invoices to patients, and ensure there are no conflicting codes billed. We can help you with all of these.
CCCM is designed for patients with multiple chronic conditions requiring more clinical staff time and more complex medical decision-making than standard CCM. It involves establishing or substantially revising a comprehensive care plan and requires a minimum of 60 minutes of clinical staff time per month.
Patients eligible for CCCM must have multiple chronic conditions expected to last at least 12 months or until the death of the patient. These conditions should place the patient at significant risk of death, acute exacerbation, or functional decline. The care plan must involve moderate or high-complexity medical decision-making.
CCCM covers the same services as CCM but with a focus on more complex cases. This includes more intensive care coordination, frequent monitoring and reassessment of care plans, and management of more complex medical needs.
For CCCM, CPT 99487 is used for the first 60 minutes per month (reimbursement: $129.93), and CPT 99489 for each additional 30 minutes (reimbursement: $68.77). These codes reflect the increased time and complexity of care required for CCCM patients.
Billing for CCCM follows similar steps to CCM but emphasizes the complexity of care provided. It includes verifying patient eligibility, documenting the comprehensive care plan, and submitting monthly claims with appropriate CPT codes. We can support you with all of these.