Chronic care management (CCM) is a critical component of primary care that contributes to better outcomes and care, yet it often requires time and effort by clinicians to provide the between-appointment services that patients need to stay on track with their treatment plans.
In recognition of this, the Centers for Medicare & Medicaid Services (CMS) established a separate payment under billing codes for the additional time and resources clinicians spend to provide that between-appointment help to Medicare and dual eligible (Medicare and Medicaid) patients. In January 2015, CMS adopted a new service code to improve payment and access to CCM services for Medicare and dual eligible beneficiaries who have two or more serious chronic conditions.
To help educate clinicians about the chronic care management codes, CMS has launched a Connected Care: The Chronic Care Management Resource education initiative. The initiative includes a healthcare professional toolkit and written materials and webinars to educate clinicians about what they need to do to bill Medicare under the codes. The first webinar takes place today, March 15th, at 3 pm.
According to CMS, CCM has been payable since 2015 under CPT code 99490. This code allows eligible practitioners and suppliers to bill $43 for at least 20 minutes of non-face-to-face clinical staff time directed by a physician or other qualified health professionals each month to coordinate care for beneficiaries who have two or more serious chronic conditions that are expected to last at least 12 months. In November 2016, CMS announced rule changes to the Medicare Physician Fee Schedule in response to feedback and insights from health care professionals across the United States to enable reimbursement for more complex and more time-intensive chronic care coordination effective January 2017.
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