{"id":10812,"date":"2020-03-30T09:00:13","date_gmt":"2020-03-30T03:30:13","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=10812"},"modified":"2025-06-17T12:11:52","modified_gmt":"2025-06-17T12:11:52","slug":"billing-guidelines-for-chronic-care-management-ccm","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-guidelines-for-chronic-care-management-ccm\/","title":{"rendered":"Billing Guidelines for Chronic Care Management (CCM)"},"content":{"rendered":"

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 is a critical component of primary care that promotes better health and reduces overall health care costs.<\/p>\n

Practitioner Eligibility<\/h2>\n

Physicians and these non-physician practitioners may bill CCM services – Certified Nurse-Midwives; Clinical Nurse Specialists; Nurse Practitioners; and Physician Assistants. Only one practitioner may be paid for CCM services for a given calendar month. This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both).<\/p>\n

CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. 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.<\/p>\n

CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an \u201cincident to\u201d basis (as an integral part of services provided by the billing practitioner), subject to applicable state law, licensure, and scope of practice. The clinical staff is either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM.<\/p>\n

CPT code 99491 includes the only time that is spent personally by the billing practitioner. Clinical staff time is not counted towards the required time threshold for reporting this code. CPT codes 99487, 99489, and 99490 \u2013 Time spent directly by the billing practitioner or clinical staff counts toward the threshold clinical staff time required to be spent during a given month.<\/p>\n

Initiating Visit<\/h2>\n

For new patients or patients not seen within 1 year prior to the commencement of CCM, Medicare requires the initiation of CCM services during a face-to-face visit with the billing practitioner (an Annual Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or other face-to-face visits with the billing practitioner). This initiating visit is not part of the CCM service and is separately billed.<\/p>\n

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 [billed separately from monthly care management services] [Add-on code, list separately in addition to primary service]). G0506 is reportable once per CCM billing practitioner, in conjunction with CCM initiation.<\/p>\n

Approaches to Help Your Practice Get Started<\/h2>\n