Chronic Care Management – Decoded (FAQ)

Chronic diseases are a long-term illness that needs special care and periodic evaluation. Conditions such as diabetes, cancer, heart diseases, high blood pressure and so require continuous care and help.

Both diagnosis and treatment cost of any chronic disease is very expensive. And, if a person has multiple chronic conditions, the costs will skyrocket. That’s where Medicare comes to play, like other health insurance it pays half of the treatment and care cost.

What is Medicare?
Medicare is a health insurance program administered by the U.S. Federal government for people aged 65 or above, and for people with certain disabilities and end-stage renal disease of any age.

What is Medicare Chronic Care Management service?
Under Medicare payment, a Chronic Care Management service will be provided to patients with multiple (two or more) chronic conditions by a physician or skilled professional per calendar month.

Examples of the chronic condition include, but not limited to, the below list

- Alzheimer’s Disease and Related Dementia		 - Heart Failure
- Arthritis (Osteoarthritis and Rheumatoid)		 - Hepatitis (Chronic Viral B & C)
- Asthma						 - HIV/AIDS
- Atrial Fibrillation					 - Hyperlipidemia (High cholesterol)
- Autism Spectrum Disorders				 - Hypertension (High blood pressure)
- Cancer (Breast, Colorectal, Lung, and Prostate)	 - Ischemic Heart Disease
- Chronic Kidney Disease				 - Osteoporosis
- Chronic Obstructive Pulmonary Disease		         - Diabetes
- Depression						 - Stroke
- Schizophrenia and Other Psychotic Disorders

What is CPT 99490?
Chronic Care Management Services, takes at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare 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

What are the new complex CCM codes?
CPT 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 healthcare professional, per calendar month

CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

How do physicians get paid for CCM services?
Mostly primary care physicians can bill for CCM service and in some cases, specialists involved in care can also bill. But only 1 practitioner can be billed per patient per calendar month for either complex or non-complex code.

What is the best way to keep track of chronic care minutes?
Care providers generally keep track of the service time. A tracking software can be used to track every minute spent on care and documentation is done for reimbursement purpose. Based on the service offerings, time will be tracked for every interaction made with the patient on a monthly basis.

How to start Chronic Care Management to patients?
Patient with multiple chronic conditions first needs to enroll for CCM care service. Then physician or care professionals will provide care according to needs of the patient. This service will be then documented for billing.

Is there any chronic disease Self- Management Program?
Yes!. A low-cost Chronic Disease Self-Management Program (CDSMP) helps chronic patients to learn how to manage and improve their own health. An interactive session will be conducted for patients with the common disease by doctors that cover pain management, nutrition, exercise, and medication use.

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Chronic Care Management – Decoded (FAQ)
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Chronic Care Management – Decoded (FAQ)
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How do physicians get paid for CCM services? Mostly primary care physicians can billl for CCM service and in some cases, specialists involved in care can also bill. But only 1 practitioner can be billed per patient per calendar month for either complex or non-complex code.
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