Requirements for Chronic Care Management

1
Requirements for Chronic Care Management
www.chronicwatch.com
2
An arrangement of care must be documented and
imparted to the patient and/or caregiver. It
ought to be thorough, in light of a physical,
mental, psychological, social, utilitarian, and
environmental assessment and address all medical
issues. CCM services are management and support
services provided by clinical staff under the
guidance of a physician or other qualified
healthcare provider to a patient living at home
or in a home, domiciliary, rest home, or assisted
living facility. The physician or other qualified
health care professional oversees and/or
supervises the management and / or coordination
of the services required for all medical
conditions, psychosocial needs, activities of
daily living.
www.chronicwatch.com
3
CPT 99490 for CCM services include, at least 20
minutes of clinical staff time directed by a
physician or other qualified health care
professional, per calendar month with the
following required elements Qualified health
care professionals treating patients with 2 or
more chronic conditions could be eligible to bill
the code. However, only 1 physician may report
these services for a given patient in a given
month. There is no defined list of diagnosis
codes that meet the requirements of CCM. Rather,
what is required is that the chronic conditions
place the patient at significant risk of death,
acute exacerbation/de compensation and that
management requires a care plan. Comprehensive
care plan established, implemented, revised or
monitored. 
www.chronicwatch.com
4
To reimburse separately for non-face-to-face care
coordination services Medicare has designed an
unique physician fee schedule for multiple
chronic conditions. CPT 99490 is the much awaited
code for treating patients with several chronic
conditions and has also been included in Centers
for Medicare and Medicaid Services PFS in 2015
onward.
www.chronicwatch.com
5

• Application of electronic care plan
•  Practices must meet the necessary care plan
  access requirement through the use of remote
  access to an EHR or portal, for example,
  web-based access to a care management
  application, use of secure messaging, or
  web-based access to a health information exchange
  service (HIE) that captures and maintains care
  plan information.
•   
•  Electronic Technology
•   Practices are not required to use a specific
  electronic technology. Electronic care plan needs
  to be accessible at all times to the clinicians
  within the practice and also with those providing
  CCM services outside of normal business hours.
  The word within the practice means any
  clinician furnishing CCM services whose minutes
  count toward a given practice's time requirement
  for reporting the CCM billing code.

www.chronicwatch.com
6

• Billing CCM with E/M and Patient Consent  
• An evaluation and management (E/M) visit may be
  billed at the same time as the CCM code, however,
  any clinical staff time on a day when the
  physician reports an E/M service may not be
  counted toward the care management service code.
  E/M services may be reported independently by the
  same physician during the same calendar month.
•  
• CCM services may only be reported if the
  patient/caregiver has given consent. A
  requirement of the service is knowledge and
  recognition by the patient that the physician or
  qualified health care professional will perform
  CCM services on the patient's behalf.
  Documentation of patient consent is pivotal in
  providing the service. The informed agreement
  process need occur only once at the start of
  furnishing the service, and it needs to be
  repeated only if the patient opts to change the
  practitioner who is delivering the services. The
  patient will be responsible for paying and the
  practice will be required to collect the 20
  co-insurance and any applicable deductibles,
  unless the patient has separate supplemental
  coverage.

www.chronicwatch.com
7
ChronicWatch 4880 Lower Roswell Road, Suite
165-238 Marietta Georgia Zip- 30068 PH-
(817)-381-6280