Complex CCM Codes To Expand Care Opportunities

On November 15, 2016 – the Centers for Medicare and Medicaid (CMS) announced the new changes to Chronic Care Management payment options by adding new codes and key improvements to the existing CCM billing methods and services.

Feedback from providers is the key reason for new codes. These changes are now set to implement on practices starting 2017 with an objective to enhance patient care and ensure hassle-free documentation for billing. Services offered by physicians will be based on the complexity of the patient’s need and will be billed under different CPT codes based on the service provided. Here is a summary of CCM and complex CCM codes.

CCM payment option till 2016

A physician will be paid $42 for 20 minutes of clinical staff time provided to patients with multiple (two or more) chronic conditions per calendar month under CPT 99490. Reimbursement for the provider will be the same if the clinical service time exceeds 20 minutes.

Changes in CCM codes effective from 2017

CMS recognized some patients may have complex chronic conditions and they might need additional care time. So, CMS addressed the need by introducing new codes 99487 and 99489 which will benefit those who need extra care and will also compensate providers with increased reimbursement options through new codes.

  • CCM Code 99490
    Payment has increased from $42 to $43 for 20 minutes of clinical staff time.
  • Complex CCM Code 99487
    60 minutes of CCM service for $94 that includes moderate to high complex medical decision-making.
  • Add-On Complex CCM Code 99489
    This code is to use with 99487. Additional 30 minutes of service will be provided for bill amount $47.

In addition to the CCM codes, there are changes made in the service elements for enhanced care and administrative simplifications on billing.

CCM Service Changes for 2017

Initiating Visit

From 2017, initial visit is required for new patients or patients who have not enrolled their name for CCM services within past twelve months. Payment of $44-$209 to be billed by the billing practitioner for initiating visits.

For initial visit, CMS has introduced a new add-on code G0506 that includes extensive assessment and care planning performed by the billing practitioner beyond the usual efforts. A payment of $64 will be billed for this extensive initiation work- only once per patient per provider.

EHR and Technology requirements

CMS continues to stress on using certified EHR with a standard format (demographics, problems, medications, medication allergies, etc.) to record core clinical information.
It also states that the use of certified technology is no longer required for CCM documentation or care plan for sharing within or outside the network. Frequent access to care document is not required, given that providers have timely information on hand or for individuals providing CCM service after hours.
At the same time, CMS recommends physician to use certified technology as per the conditions of Medicare Physician Fee Schedule (PFS) payment to get points for the Quality Payment Program (QPP)
Beginning 2017, care plans can also be shared through fax as it has created more fuss last year among some providers when shared electronically.

Care Management

From now, the clinical summary is renamed as “continuity of care document(s)” and a care management plan copy given to patient requires no format. Usage of certified technology has been completely removed in this revision.
Beneficiary and caregivers are given the opportunity to communicate with the practitioner, not only through telephone, but also by means of secure messaging, Internet, or through any non-face-to-face communication methods.

24 hours access to care

Patients and caregivers are provided access to any of the physicians or other qualified professionals or clinical staff to make quick contact to address urgent care needs, not just for chronic care needs.
Continuous relationship with a designated member of the care team is improved to schedule quick and routine appointments.

Consent Change

Consent can be either verbal or written, but it must be documented in the patient record and the same should be explained for transparency.