Who Can Provide Chronic Care Management (CCM) Services?

Chronic care management (CCM) is a set of face-to-face services offered to beneficiaries with two or more chronic conditions expected to last 12 months or indefinitely. The Centers for Medicare and Medicaid Services (CMS) recognizes CCM as a critical component of primary care that promotes better health for patients and reduces total healthcare costs.

Comprehensive CCM Coding

Five Current Procedural Terminology (CPT) codes are used to report CCM services, including medical procedures and otherwise. These are used for processing claims, evaluating healthcare utilization, conducting research, developing medical guidelines, and other documentation. 

1. CPT code 99490: This refers to non-complex CCM, which is a 20-minute timed service provided by the clinical staff to coordinate care across providers. It also supports patient accountability.
2. CPT code 99439: This means that every additional 20 minutes of clinical staff time spent to provide non-complex CCM led by a physician or any qualified healthcare professional is billed alongside CPT code 99490.
3. CPT code 99487: This refers to complex CCM, which is a 60-minute timed service provided by the clinical staff to establish or revise a comprehensive care plan involving moderate to high-complexity medical decision-making.
4. CPT code 99489: This means that every additional 30 minutes of clinical staff time spent to provide complex CCM led by a physician or any qualified healthcare professional is billed alongside CPT code 99487. However, it cannot be billed with CPT code 99490. 
5. CPT code 99491: This refers to CCM services personally provided by a physician or any qualified healthcare professional for at least 30 minutes. 

Who Can Provide and Bill CCM Services?

Only one physician or qualified health care professional assuming the care management role for a beneficiary can bill for CCM services to a patient. While services may be provided by clinical staff, the service must be billed by one of the following:

• Physician
• Clinical nurse specialist (CNS)
• Nurse practitioner (NP)
• Physician Assistant (PA)
• Certified nurse-midwife

Non-physicians must be legally authorized and qualified to provide CCM services in the state they provide such services.

Why Are CCM Services Important?

Beneficiaries eligible to receive CCM services benefit from more support and resources that help manage their chronic conditions effectively. More coordinated care promotes better health and reduces overall health care costs.  As the American healthcare system shifts from a fee-for-service model to value-based payment, billing CCM services lets physicians get paid for the time and effort invested in caring for their patients with chronic care conditions. 

The Chronic Care Model

Thanks to technology, the Chronic Care Model enhances the quality of care and access to CCM services. It identifies key elements of the model crucial in making successful outcomes:

• Health System, which serves as the foundation for the service by providing structure and goals.
• Community, which links community resources and establishes policy
• Self-Management Support, which aids patients in acquiring the skills and confidence to self-management.
• Decision Support, which assures that providers have access to evidence-based guidelines 
• Clinical Information Systems, which offer timely access to data about patients and patient populations.
• Delivery System Design, which restructures medical practices to facilitate team care.

Conclusion

CCM services offer comprehensive support to patients with chronic conditions, helping physicians provide care more effectively and improve communications with other treating clinicians. Overall, it allows patients to optimize benefits while reducing costs and lets physicians get paid right.  Whether your patient has chronic conditions, behavioral health conditions, or just needs help transitioning out of an inpatient facility, Medistics Health is there to simplify their experience. We provide care management services that save you time, increase patient engagement, and deliver a better patient experience. Our primary goal is to humanize healthcare with a focus on chronic care management. Get in touch with us today and let us know how we can help!