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Chronic care management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. The Centers for Medicare & Medicaid Services (CMS) recognizes that CCM services include critical components of primary care services that promote better health and reduce overall health care costs. Lara Health platform supports CCM as one of the modules. Learn how chronic care management works.
Patients with two or more chronic conditions qualify and CMS provided a wide interpretation of a chronic condition, making it applicable for many older patients. Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services. Examples of chronic conditions include, but are not limited to, the following:
Chronic care management services can be performed by physicians looking after patients who benefit however, it’s most suitable for the primary care providers to take on this service. It’s important to understand that only one provider can bill for this service so a patient in care of more than one PCP or those with a specialist involved have the right to choose. The CCM service is not within the scope of practice of limited-license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care.
Most primary care providers already do services that fall under chronic care management and so adding a CCM service simply means they are now allowed to be reimbursed for it. Covered services include, but are not limited to:
A lot of the ongoing care is performed by the clinical staff and a well designed program makes it easy for them to deliver a high quality of patient care.
The CCM codes describing clinical staff activities (CPT 99487, 99489, and 99490) are assigned general supervision under the Medicare PFS. General supervision means when the service is not personally performed by the billing practitioner, it is performed under his or her overall direction and control although his or her physical presence is not required
Lara Health includes a comprehensive CCM module built into the platform. Schedule a demo to see how easy it is to add CCM and other services into your practice (link)
Complex CCM (CPT code 99487) shares common required service elements with CCM, but has different requirements for the complexity of medical decision making involved (which is moderate to high complexity) and the amount of time clinical staff provides (at least 60 minutes).
For new patients or patients not seen within 1 year prior to the commencement of CCM, Medicare requires initiation of CCM services during a face-to-face visit with the billing practitioner (an annual wellness visit or initial preventive physical exam, or other face-to-face visit with the billing practitioner). This initiating visit is not part of the CCM service and is billed separately. Practitioners who furnish a CCM initiating visit and personally perform extensive assessment and CCM care planning outside of the usual effort described by the initiating visit code may also bill HCPCS code G0506 (comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services). G0506 is reportable once per CCM billing practitioner, in conjunction with CCM initiation.
When a patient is enrolled into a chronic care management program, practitioner creates a comprehensive care plan for all health issues. It typically includes, but is not limited to, the following elements:
Lara Health’s multi-care optimization platform stacks the most impactful care models and digital tools onto one integrated platform, making it easy for practitioners to deliver the best possible care to their patients in the most efficient way. Using Lara Health means admin work is reduced and reimbursements simplified so doctors can reclaim their time and their clinical teams work more efficiently.
Source: AAFP and CMS