• Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least a year.
• Medical offices often question the correct way to code for CCM for Medicare. CodingIntel provides the correct way to utilize CPT^® 99490, 99439, 99491, 99437, 99487, and 99489.
• See also Principal Care Management
• And, download our Care Management Coding Guide and CCM Quick Reference Sheet

Use of CPT^® codes 99490, 99439, 99487, 99489, 99491 and HCPCS code G0506

Chronic care management services are service provided to patients who have medical and/or psychosocial needs requiring establishing, implementing and monitoring a care plan. By definition, they are for patients who have two or more chronic illness expected to last for at least 12 months, or until the death of the patient, that place them at significant risk of death, acute exacerbation/decompensation or functional decline.

Some of the codes describe care provided by a physician or non-physician practitioner (NPP), and some describe services performed by clinical staff under the supervision and direction of a physician or NPP. If a physician or NPP provides the service, do not double count time spent in any other, billable activity. All contributing activities performed are for the period of time during a calendar month.

Chronic care management does not require moderate or high MDM. “Both chronic care and complex chronic care management address, as needed, all medical conditions, psychosocial needs, and activities of daily living.”  ^[1]

Additional requirements:

• CMS requires verbal or written consent from the patient, and this consent must be documented in the medical record.
• Development of a comprehensive care plan.
• The patient must have a designated physician/NPP as their clinician and have 24/7 access to address urgent needs (this can be met by personnel trained to triage or provide clinical care, or outsourced to a third-party vendor who can provide this coverage if you do not have enough staff to meet this requirement).
• The practice must use a certified electronic health record, although faxing is allowed to share the care plan.
• Use a standardized method to identify patients who are eligible for the service.
• Manage care transitions.
• Give a copy of the plan to the patient.
• For CMS, supervision is general. This means that the physician or NPP who is supervising the work done by clinical staff does not need to be in the same place when the work is done.