Eligibility For Chronic Care Management

Centers for Medicare and Medicaid Systems (CMS) established CPT 99490 / G0511 to help facilitate better health and care for individuals that have two or more chronic conditions expected to last at least 12 months, or until the death of the patient. These chronic conditions place the patient at significant risk of death, acute exacerbation / decompensation or functional decline. For a patient to be eligible for Chronic Care Management, they must have at least two of these symptoms. 

Examples of Illnesses that are Eligible for Chronic Care Management:

• Alzheimer’s Disease and Related Dementia
• Arthritis (Osteoarthritis and Rheumatoid)
• Asthma
• Atrial Fibrillation
• Autism Spectrum Disorders (ASD)
• Cancer
• Cardiovascular Disease
• Chronic Obstructive Pulmonary Disease
• Depression
• Diabetes
• Hypertension
• Infectious Diseases such as HIV/AIDS
• And Others

CCM includes 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, CCM services also include structured recording of patient health information, maintaining a comprehensive electronic care plan, managing transitions of care and other care management services, and coordinating and sharing patient health information timely within and outside the practice. Because of this managed care, a patient’s care coordinator can help facilitate additional scheduled services to treat issues that may have otherwise gone un-noticed by the patient. Therefore, Chronic Care Staffing’s CCM Program may increase billed visit per patient.