CMS Medicare Chronic Care Management – New CPT Code and Guidelines

CMS increased the reimbursement rate for CCM and released the new CPT codes for beneficial billing and reimbursements for healthcare professionals.

You’re probably aware of this if you work in the medical field. However, do you understand the rates and guidelines for Medicare chronic care management?

If not, this blog will help you clear your doubts and provide you with the latest and most valuable information about the CCM and how you can increase your practice efficiency by successfully meeting CMS guidelines.

What is Chronic Care Management (CCM)?

Chronic care management is the care service that provides coverage to patients with two or more chronic conditions. CCM is comprehensive care provided outside of a clinic or office setting.

CCM allows healthcare professionals to be reimbursed for services and other resources provided to patients through care planning, remote communication, medication management, and care coordination between providers. It includes face-to-face patient visits, telephone, and email conversations, review of medical records and results, and educating and supporting healthcare services. The patient care team bills for the time spent managing patients’ conditions.

What Are CMS Chronic Care Management CPT Codes?

The Current Procedural Terminology (CPT) codes provide the uniform language for the medical services and procedures. These codes are used for billing for the health care services provided to the patient; encapsulating the particular services into one code makes it easy to understand by everyone from healthcare professionals to insurance companies as well.

CPT codes provide a universal terminology used to report medical services for monitoring, consulting, and providing healthcare by clinical staff, physicians, practitioners, and other healthcare providers. The services include processing claims, developing care plans, supporting calls and messages, and other healthcare documentation.

After the first visit and the consent of the patient to undertake the CCM services, the CPT codes are used for monthly bills. Every code reflects different amount of time and services, categorized into two parameters according to the health conditions. Let’s look at the CMS chronic care management codes:

CPT Codes for Non-Complex CCM

• CPT Code 99490 – services provided for 20 minutes by clinical staff to coordinate care.
• CPT Code 99439 – additional 20 minutes of services provided by clinical staff (billed with inclusion on 99490).
• CPT Code 99491 – services provided by a physician or other qualified healthcare professional for at least 30 minutes.
• CPT Code 99437 – additional 30 minutes of services provided by a physician and other eligible healthcare professionals (billed with inclusion on 99491).

CPT Codes for Complex CCM

• CPT Code 99487 – services provided for 60 minutes by clinical staff that involve moderate to severe medical decision-making.
• CPT Code 99489 – each additional 30 minutes of services provided by clinical staff directed by physician and other healthcare professionals (billed with inclusion on 99487 but cannot be billed with 99490).

Also Read: Remote patient monitoring companies for hospitals

How Does HealthArc Chronic Care Management Help Healthcare Professionals?

Chronic care management programs begin with the first face-to-face meeting between the health care professional and the patient. Qualified professionals include physicians, certified clinical nurse specialists, nurse practitioners, and physician assistants.

Professionals provide a comprehensive care plan to patients after the first meeting and monitor each month through daily metrics and readings by healthcare software so that the patient does not have to visit doctors daily.

HealthArc is a healthcare software that allows physicians to easily monitor their patients from a web-based portal easily accessed from laptops, desktops, tablets, and mobile phones.

The HealthArc dashboard provides easy-to-understand daily metrics for physicians to track patients’ status. It helps healthcare providers improve patient engagement with interactive features to share their reports through messaging and even interact with audio/video calls.

How to Bill for Chronic Care Management?

Required elements and criteria to bill for CCM:

• Patients with two or more chronic conditions.
• Chronic conditions must be expected to last at least a year or until the death of the patient.
• There must be a comprehensive care plan.
• At least 20 minutes of care services are provided within a month.
• The patient’s agreement or consent is on file for undertaking the chronic care.

2024 Medicare Reimbursement for Chronic Care Management Codes

Medicare reimburses health care professionals and other care providers and care coordination staff for the medical services provided on the fee structure modules. CMS released the CCM reimbursement fee schedule for chronic care management, which is stated to be beneficial for healthcare providers. These are national average reimbursements and differ for each state and zip code.

Reimbursement rates for non-complex chronic care management services:

Reimbursement rates for complex chronic care management services:

Chronic Care Management: Successful Procedure

The CCM program provides effective access to healthcare delivery for chronic patients and reduces the risk of hospitalization while reducing costs for patients.

To ensure a successful care process and meet the requirements of the CCM program while providing effective care, follow the best practices outlined below:

Know Healthcare Professionals, Organizations and Facilities are Eligible to Bill for CCM
FQHCs, RHCs, certified physicians, and hospitals are eligible to bill for CCM services. The following non-physicians that can also bill for CCM services are:

• Clinical nurse specialists/nurse practitioners
• Certified nurse midwives
• Physician assistants

Establish Comprehensive Care Plans
To fulfill CCM requirements, healthcare providers must provide comprehensive care plans for patients and caregivers.

A care plan should include the following:

• The expected outcomes, the treatment goals and barriers.
• List of all health problems, including chronic conditions and their symptoms.
• Evaluation of patient’s physical and physiological needs.
• Ongoing medication services and management processes.
• Resources and professionals involved in the care management.

Document the Time Spent
The CCM reimbursement and billing criteria are emphasized around the time given for the services. Providers must document the time spent providing CCM services in their records. These include time on calls, prescriptions, reconciliation, and other care coordination and healthcare facilities.

Affiliate with Care Coordination Services
Partnering with care coordination services will be beneficial yet time-consuming for you. HealthArc is one of the best providers to help you deliver better patient outcomes with advanced analytics.

Collaborating with HealthArc will improve patient engagement and care for chronic patients and increase the practice revenue.

FAQs for Medicare Chronic Care Management

1. Is it necessary to take patients’ consent only in writing?

The patient consent  can be both verbal and written and it must be documented in the EMR

2. What is the difference between CCM and CCCM?

Chronic Care Management (CCM) – covers 20 minutes of clinical staff time per month for managing and providing care services for non-complex chronic conditions.

Complex Chronic Care Management(CCCM) – covers 60 minutes of moderate to severe division, making for complex chronic conditions.

3. Is there any benefit from CCM?

The benefits are both for practitioners and the patients. The providers get the appropriate fees and reimbursements with the CCM billing codes, and the patients receive better healthcare monitoring with enhanced healthcare support.

Improve Efficiency with HealthArc’s Chronic Care Management Software

As we have tried to convey from this blog, partnering with care coordination services will enhance your chronic care management services and allow you to focus more on medical work rather than spending time on other managerial and testing tasks.

HealthArc’s software will take care of all the EHRs and automatically bill for services and reimbursements to save time without any errors. The HealthArc Dashboard provides easy-to-understand daily metrics for physicians to track patient status.

HealthArc automates the billing reports, which helps physicians reduce the burden, and they can effectively focus on patient monitoring and care services. So contact us today to deploy your CMS Medicare Chronic Care Management Solution.

Schedule a demo today to learn more about billing and reimbursement of chronic care management.