Chronic Care Management (CPT 99490 / G0511)
Chronic Care Management (CCM) national reimbursement is $42.17. CCM requires twenty minutes of non face to face monthly activity on behalf of enrolled patients. Who’s eligible? Any Medicare and Medicare Advantage patient with two or more chronic conditions.
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What is Chronic Care Management?With regard to the Medicare Physician Fee Schedule (CPT 99490 / G0511), Chronic Care Management (also known as CCM) is the non face-to-face care for chronically ill patients that occurs between regular office visits in an effort to address many of the issues that prohibit a patient’s ability to manage their conditions. Chronically ill is defined as patients that have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.
What Are Examples Of Chronic Conditions That Are Eligible For Chronic Care Management?Illnesses that are eligible for Chronic Care Management include, but are not limited to: Alzheimer’s disease and related dementia, Arthritis (osteoarthritis and rheumatoid), Asthma, Atrial fibrillation, Autism spectrum disorders, Cancer, Cardiovascular Disease, Chronic, Obstructive Pulmonary Disease, Depression, Diabetes, Hypertension, Infectious diseases such as HIV/AIDS.
Who Is Eligible To Receive Chronic Care Management?Any medicare patient that has 2 or more chronic conditions is eligible for this program. Centers for Medicare and Medicaid Services (also known as CMS) guidelines simply require the patient to meet the following criteria: 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 inability to manage their symptoms or condition itself.
What Is Required Of The Provider Of Chronic Care Management?CCM services include at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, for each patient that has met eligibility requirements as detailed by Medicare. Eligibility requirements are defined as: 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. A comprehensive care plan must be established, implemented, revised, or monitored.