Chronic Care Management

Chronic care management includes a comprehensive care plan that lists serious health problems and goals, other providers, medications, community services needed, and other information about the health of the patient. It also explains the care a patient needs and how the care will be coordinated.  The health care provider will provide an agreement to the patient to provide chronic care management.

Then, the provider prepares the care plan, helps with medication management, provides 24/7 access for urgent care needs, provides support when the patient goes from one health care setting to another, reviews medications and how the patient takes them, and helps with other chronic care needs.

For 2 or more serious chronic conditions (like arthritis and diabetes) that are expected to last at least a year, Medicare may pay for a health care provider’s help to manage those conditions.

Reimbursement Reviews

According to research performed by a highly successful RPM software, most providers have reported seeing independently documented average outcomes of 29% reduction in hospitalizations, 87% patient retention at one-year, and average net-new revenue exceeding $6,800 per provider per month with 91% patient satisfaction, you too can be clinically, financially and operationally successful with chronic care management, principal care management, transitional care management, remote patient monitoring, and behavioral health integration.

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CCM Reimbursement

Chronic Care Management - CPT Codes

99490

The first full 20 minutes of non-complex Chronic Care Management of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:

 

·Multiple (2 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.

Medicare Part B Providers or Qualified Health ProfessionalsOnce per month - $41.17

99487

The first 60 minutes of clinical staff or QHP or provider time for moderately or highly complex CCM.Medicare Part B Providers or Qualified Health ProfessionalsOnce per month - $91.77.

99489

An additional 30 minutes of time spent in the same billing cycle as 99487 with high or moderate complexity patients who require more time.Medicare Part B Providers or Qualified Health ProfessionalsOnce per month - $43.97

Principal Care Management

G2064

An interaction between a physician or non-physician practitioner with a patient with one chronic disease or high-risk condition lasting at least 30 minutes per calendar month.Medicare Part B Providers or Qualified Health ProfessionalsOnce per month - $90.37

G2065

An interaction between clinical staff with a patient with one chronic disease or high-risk condition lasting at least 30 minutes per calendar month. Medicare Part B Providers or Qualified Health ProfessionalsOnce per month - $38.73

Transition Care Management    

99495

Transitional Care Management services, including interactive contact with the moderately complex patient within two days of discharge, with a face-to-face visit within 14 days of discharge.Medicare Part B Providers or Qualified Health ProfessionalsOnce per discharge - $207.96

99496

Extra care incentives for highly complex patients with interactive contact within two days of discharge for TCM services, with a face-to-face visit within seven (7) days of discharge.Medicare Part B Providers or Qualified Health ProfessionalsOnce per discharge -  $281.59