Chronic Care Management (CCM) is a benefit offered by Medicare that allows a patient to receive healthcare under the supervision of a physician or a non-physician healthcare worker. The service is provided to a person with two or more chronic conditions. Through this program, patients can receive services outside the doctor’s visits which help in planning and preventative healthcare. Let us look at some of the commonly asked questions about CCM billing.
What CCM Codes Are Under Physician Fee Schedule (PFS) codes?
Medicare uses codes to reimburse physicians for their services. Here are some billing codes that practitioners should provide:
- CPT Codes 99487 involves complete chronic care management service offered within the first 60 minutes of interaction with the patient per calendar month. There is the CPT Code 99489 add-on code for this code that compensates healthcare providers for every 30 minutes they spend with the patient per calendar month.
- CPT Code 99490- for clinical staff who offer CCM services for a minimum of 20 minutes under the direction of a physician or professional healthcare provider per calendar month. This code also has an add-on code, 99439, which reimburses the clinical staff for every additional 20 minutes, still directed by a physician or a professional healthcare provider. This code was adopted in 2021 after the CY final rule and replaced code G2058 of HCPCS.
- CPT code 99491- for health professionals offering CCM services for at least 30 minutes per calendar month. The add-on code for this is CPT Code 99437. Which reimburses the provider for every extra 30 minutes they spend with a patient per monthly calendar.
Related Article: How to Implement an In-house CCM Program
Who Is a Clinical Staff Referred in CCM Codes Describing the Time a “Clinical Staff” Spends Per the Calendar Month?
According to the CPT Codebook, a clinical staff member is someone who works under the supervision of a physician or another health professional and is legally allowed to assist in offering specified services but does not directly report the professional service they offer. The specific services depend on the particular policies.
Please note that while other clinical workers can assist in offering CCM services, only the time a clinical staff defined by the CPT Codebook is reimbursed.
Must a Clinical Staff Spend the Same Amount of Time as Per the CPT Code Each Month to Bill CCM?
No, the time limits are standard for evaluating and managing office visits. The time limit on each code is assumed time-based on the survey conducted by the American Medical Association on physicians. It represents the time a billing practitioner uses to direct clinical staff, perform duties themselves, and sometimes make moderate to highly sophisticated medical decisions.
How Can Non-Physicians Providers (NNPs) Who’re Not Allowed to Bill Directly Participate in CCM?
Social workers, dieticians, pharmacists, and non-physicians cannot bill for CCM directly. But they can still offer their services and get compensated. Medicare allows most of these professionals to participate in CCM under “clinical staff.” That means they can offer their services under the supervision of a qualified non-physician practitioner. That is provided that they meet the requirements for “incident to.”
Since a clinical staff member is a member of the care team, they may perform certain duties, including collecting structured data, maintaining or informing updates for the care plan, managing care, and providing 24/7 access to care, among other things.
When Should CCM Billing Be Submitted?
Medicare allocates one calendar month for CCM services. Therefore, providers can file CCM claims after this service period or once they complete the minimum required time for offering CCM services.
Can Practitioners Bill for CCM Services Offered in Nursing Homes or Other Facilities?
Yes. CCM services are billed under the PFS for facility and non-facility settings. Please note that the Place of Service (POS) indicated on the claim needs to be where the provider would offer face-to-face services with the patient.
What POS Should the Physician Indicate on the Claim?
As mentioned above, it should be in a location that allows them to offer face-to-face services to the beneficiary. It could be in a facility or non-facility.
Final Thoughts
Well, there are some medical FAQs many providers ask. Please note that CCM billing can be confusing. That is why many practitioners outsource their CCM services. However, we hope we have answered some of the questions you have. As well as help you with knowing where to start.
