CCM - Complex Chronic Care Management

CPT Codes

99487 - Complex chronic care management services can be billed with following criteria are met

• 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
• Establishment or substantial revision of a comprehensive care plan
• Moderate or high complexity medical decision making

Complex chronic care management services of less than 60 minutes duration, in a calendar month, are not reported separately

99489 - Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure). 

Report 99489 in conjunction with 99487. 

Do not report 99489 for care management services of less than 30 minutes additional to the first 60 minutes of complex CCM services during a calendar month.

Guidelines

60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both).

Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately

Eligible Provider's

• Physicians and the following non-physician practitioners may bill CCM services,
• Certified Nurse Midwives
• Clinical Nurse Specialists
• Nurse Practitioners
• Physician Assistants

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.

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 “incident to” basis (as an integral part of services provided by the billing practitioner)

A comprehensive care plan for all health issues typically includes, but is not limited to, the following elements,

• Problem list
• Expected outcome and prognosis
• Measurable treatment goals
• Symptom management
• Planned interventions and identification of the individuals responsible for each intervention
• Medication management
• Community/social services ordered
• A description of how services of agencies and specialists outside the practice are directed/coordinated
• Schedule for periodic review and, when applicable, revision of the care plan

Initiating Visit 

• Initiation during an AWV, IPPE, or face-to-face E/M visit (Level 4 or 5 visits not required), for new patients or patients not seen within 1 year prior to the commencement of CCM services.

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

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.

Note: The billing practitioner cannot report both complex CCM and non-complex CCM for a given patient for a given calendar month. Do not report 99491 in the same calendar month as 99487, 99489, 99490.

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