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Medical Coding News Archives

New Initiative Highlights Chronic Care Management for Medicare Beneficiaries

April 26, 2017:

In March, the Centers for Medicare and Medicaid Services (CMS) announced a new educational initiative to raise awareness of chronic care management among providers and in the community. The campaign, dubbed Connected Care, will focus particularly on racial and ethnic minorities and rural beneficiaries with multiple chronic conditions. This program comes on the heels of an expansion of coverage for these services effective January 2017.

The program could have a significant impact, considering that two-thirds of Medicare beneficiaries have two or more chronic conditions. Some providers managing these conditions and coordinating care are not aware of the separate payments for chronic care management under the Part B physician fee schedule and may be short-changing themselves.

Connected Care is three-pronged: One effort involves providing information on chronic care management (CCM) to providers, one on encouraging community organizations to get involved, and one on educating patients. On the provider side, the campaign offers a toolkit with information on and resources such as webinars for implementing CCM. A “partner” toolkit is also available to educate community groups, such as churches and local health departments, about CCM and enlist them in promoting this kind of care to the public. For patient education, the program offers a poster and a postcard that explain in English and Spanish what CCM is and urge beneficiaries to ask their providers about Connected Care.

The materials can be accessed at go.cms.gov/ccm, where they can be ordered for free.

Expansion of Coverage for CCM

In January 2015, CMS began covering non-face-to-face CCM services reported under CPT code 99490. These services may be provided by clinical staff under the direction of a physician or other qualified health professional to beneficiaries whose multiple chronic conditions are expected to last at least one year or until the patient’s death. Only one practitioner can bill for these services per month.

The services included are:

  • Use of an electronic health record
  • Ensuring continuity of care with a designated care team member
  • Providing comprehensive care management and care planning
  • Providing transitional care management
  • Coordinating with home- and community-based clinical service providers
  • Offering access to care for urgent needs 24 hours a day, seven days a week
  • Offering “enhanced” communication, such as email
  • Obtaining patient consent in advance

99490   Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care 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

Note that CCM services that take less than 20 minutes are not reported separately.

Beginning January 2017, CMS expanded its coverage of CCM to two more codes to encompass more complex and time-intensive care coordination: 99487 (Complex chronic care management services) and 99489 (Complex chronic care management services; each additional 30 minutes). The nonfacility payment can now range from $43 to more than $141, depending on the complexity of the patient’s condition.

The agency also scaled back its requirements for initiating CCM from all patients to just those who are new or who have not been seen within the previous year. Providers now can bill with add-on code G0506 along with the code for the initiation of CCM services when they personally provide extensive assessment beyond what is usually needed. CMS also streamlined the administrative burden of reporting these services and extended coverage to services provided in federally qualified health centers (FQHCs) and rural health clinics (RHCs), though only code 99490 is covered in these settings and add-on code G0506 cannot be used when reporting initiating visits.

G0506   Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services, including assessment during the provision of a face-to-face service

CPT copyright 2016 American Medical Association. All rights reserved.


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