Chronic Care Management
The Chronic Care Management program is an evidence-based model that focuses on chronic-care illnesses, such as late-life depression. The program incorporates physicians, nurses, social workers and others onto a patient's team to address social determinants of health through the behavioral health framework. Personalized treatment plans with follow-ups and regular monitoring are used to help patients address their medical goals.
Chronic Care Management (CCM)
Definition: Chronic Care Management (CCM) is care coordination service completed outside of the regular office visit, and conducted by a physician or non-physician practitioner (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist and/or Certified Nurse Midwife) and their clinical staff. This service is provided on a per calendar month basis for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until death, that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.
Purpose: CCM serves to function as a critical component of primary care that contributes to better overall health and care for individuals.
Impact: Half of all American adults currently live with a chronic condition, and as many as one in four live with more than 2 chronic conditions. People with chronic conditions account for 86% of national healthcare spending.
Availability: Patients currently enrolled in Medicare that live with two or more chronic conditions such as arthritis, diabetes, depression, or high blood pressure, are eligible for CCM services. Chronic care management services may include:
· At least 20 minutes a month of CCM services
· Personalized assistance from a dedicated healthcare professional who will work with you to create a care plan
· Coordination of care between your pharmacy,specialists, testing centers, hospitals, and more
· 24/7 emergency access to a health care professional
· Expert assistance with setting and meeting your health goals
Billing Category: Chronic Care Management
CPT Code: 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, with the following required elements:
· Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
· Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
· Comprehensive care plan established, implemented, revised, or monitored. Assumes 15 minutes of work by the billing practitioner per month.
CPT Code: 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, with the following required elements:
· Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
· Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
· Comprehensive care plan established, implemented, revised, or monitored.
CPT Code: 99487 – Complex chronic care management services, with the following required elements:
· Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
· Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
· Establishment or substantial revision of a comprehensive care plan
· Moderate or high complexity medical decision making
· 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
CPT Code: 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
