Chronic Care Management Coding & Billing Guide

Chronic care management (CCM) plays a vital role in the advanced healthcare system, specifically as the number of individuals living with long-lasting cases continues to increase. In the USA, nearly 129 million people suffer from at least one severe health condition, alsmost 90% of healthcare spending is on severe and mental health. Managing these individuals effectively needs persistent care coordination beyond regular office visits.

DocVaz Medical Billing Company helps healthcare providers by providing certain medical billing services from severe care management. This confirms accurate coding, compliance with CMS instructions, and maximizes the repayment methods. This instruction explains chronic care management coding, billing rules, and repayment chances to support practices’ success.

What is Chronic Care Management (CCM)?

Chronic care management refers to non-face-to-face care coordination facilities delivered to individuals with severe conditions expected to reach the end of life. These facilities involve medical management, a proper diet plan, patient education, and coordination with experts.

CCM permits the providers to offer continuous, proactive care while being compensated for the time spent controlling patients outside of traditional visits. With the perfect medical billing services, CCM can become the most realistic monthly income stream.

Chronic Care Management CPT Codes Explained

CCM CPT codes are categorized into non-complex and complex, based on the patient’s level of care needs.

Non-Complex Chronic Care Management CPT codes

These codes apply to individuals with multiple severe conditions that need ongoing ministering but do not involve intensive care coordination.

CPT 99490

• At least 20 minutes of non-face-to-face care per month.
• Individuals with two or more severe conditions.
• Medicare repayment: approximately $62 per patient per month.

CPT99439

• Every additional 20 minutes beyond CPT 99490.
• Medicare reimburses approximately $46 per 20 minutes.

CPT 99491

• Initial face-to-face visit.
• At least 30 minutes with a physician or qualified healthcare expert.
• Medicare repayment: approximately $83

CPT 99437

• Subsequnt face to face vists.
• Billed in 30-minute increments beyond the initial visits.
• Medicare reimbursement: approximately $21 per 30 minutes.

Complex Chronic Care Management CPT codes

Complex CCM applies when individuals have multiple serious or higher-risk conditions needing extensive coordination.

CPT 99487

• Minimum 60 minutes of non-face-to-face care per month.
• Used for persons with numerous comorbidities.
• Medicare repayment: approxmiately $133 per month.

CPT 99489

• Every additional 30 minutes beyond CPT 99487.
• Medicare reimbursement: approximately $76 per 30 minutes.

Accurate reporting of these codes is crucial, which is why many practices partner with DocVaz Medical Billing Company for professional CCM billing support.

Patient Eligibility for Chronic Care Management

To qualify for CCM facilities, patients must:

• Have two or more severe conditions.
• Conditions must last at least 12 months or until the end of life.
• Conditions must place the individuals at risk of functional decline, acute exacerbation, or mortality.

Common qualifying detects involves diabetes, hypertension, COPD, asthma, severe kidney disorders, neurological diseases, cancer, and chronic mental health situations.

Key Billing requirements for CCM services

CMS outlines limited instructions for billing proper care management services. The healthcare providers must confirm:

• Initiating visits: a qualifying face-to-face visit to establish care and criteria.
• Patient consent: written or documented verbal consent in the file.
• Care plan: a comprehensive, individual-focused care plan.
• Time tracking: exact monthly documentation of time spent.
• 24/7 access: Individuals must have access to care management facilities.
• Provider oversight: Medical staff operate under general supervision.

Professional medical billing services help confirm all needs are met to prevent denials.

Documentation and Claim Submission

Proper documentation is the main foundation of successful CCM repayment. Practices must be documented:

• Total CCM time per patient.
• Care coordination activities.
• Medication management.
• Patient education and counseling.
• Communication with a professional.

Claims are submitted by utilizing the CMS 1500 form, preferably through electronic systems for rapid processing. DocVaz medical billing comapny manges end to end CCM billing, from time tracking to claim submission and follow-up.

FAQ’s