What is Complex Chronic Care Management – All you need to know

Chronic Care  Management

The Centers for Medicare & Medicaid Services (CMS) considers Chronic Care Management (CCM) as a crucial part of primary care. Chronic Care Management is non-face-to-face care provided to Medicare patients with two or more chronic conditions. It contributes to better health services to people. In 2015, Medicare started to reimburse a certain amount for the Chronic Care Management services under the Medicare Physician Fee Schedule (PFS).

Service 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, 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 care provider, per calendar month
  • CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified      care provider, per calendar month (List separately in addition to code for primary procedure)

Difference Between CCM and Complex CCM

CCM (“non-complex” CCM) and complex CCM services have similar health service elements. They differ in the following aspects,

  • Amount of clinical staff service time provided
  • Involvement and work of the billing practitioner
  • The extent of care planning performed

According to Medicare, “Complex Chronic Care Management services of less than 60 minutes in duration, in a calendar month, are not reported separately. Practitioners must report CPT 99489 in conjunction with CPT 99487. They must not report CPT 99489 for care management services of less than 30 minutes along with the first 60 minutes of Complex Chronic Care Management services during a calendar month.”

Eligibility Criteria for Care Providers

Physicians and the following non-physician practitioners may bill CCM services:

  • Certified Nurse Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants

Patient Eligibility

Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions

  • Expected to last at least 12 months or until the death of the patient
  • Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline

As Chronic Care Management services have reimbursements, physicians must consider administering CCM to the eligible Medicare patients. The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex Chronic Care Management services during a given service period, not both.


The Complex CCM codes (CPT 99487, 99489) come under the general supervision according to Medicare PFS. A billing practitioner need not give the health service personally. Any qualified care provider can give the service under the billing practitioner’s overall direction and control. The billing practitioner’s physical presence is not required.

CCM Service Summary

Care providers give a non-complex or complex Chronic Care Management service through the following steps,

  1. Initiating Visit – Medicare requires initiation of CCM services for new patients or patients not seen within one year of commencement of CCM. It is a face-to-face visit with the billing practitioner. It includes an Annual Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or other face-to-face visits. This initiating visit is not part of the CCM service and is separately billed.           
  2. Structured Recording of Patient Information Using Certified EHR Technology –  Structured recording of patient’s demographics, problems, medications, and medication allergies using certified Electronic Health Record (EHR) technology.
  3. Comprehensive Care Plan – A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment. The care provider must,
  • Provide the patient and/or caregiver with a copy of the care plan
  • Ensure the electronic care plan is available and shared timely within and outside the billing practice to people involved in the patient’s care
  1. 24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified care providers or clinical staff and continuity of care with a designated member of the care team.
  2. Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.

HealthViewX Chronic Care Management solution features

HealthViewX Chronic Care Management solution has the following features that make the process simpler,

  • Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
  • Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
  • Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
  • Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
  • Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the reimbursements.
  • HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution has features that satisfy non-complex and complex CCM services. Medicare reimbursements for Chronic Care Management services increase the profits for community health centers. It also benefits patients with multiple chronic health conditions. To know more about our Chronic Care Management solution, schedule a demo with us.