CCM Services Changes for 2017

What is CCM?

Chronic Care Management (CCM) services by a physician or non-physician practitioner (Physician Assistant [PA], Nurse Practitioner [NP], Clinical Nurse Specialist [CNS], Certified Nurse-Midwife [CNM]) and their clinical staff, per calendar month, for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. Only 1 practitioner can bill CCM per service period (month).

The included services are:

  • Use of a Certified Electronic Health Record (EHR)
  • Continuity of Care with Designated Care Team Member
  • Comprehensive Care Management and Care Planning
  • Transitional Care Management
  • Coordination with Home- and Community-Based Clinical Service Providers
  • 24/7 Access to Address Urgent Needs
  • Enhanced Communication (for example, email)
  • Advance Consent

Key Improvements for 2017

Increased payment and additional codes (Table 1) – For 2016, the single CCM code paid approximately $42. Now there are 3 codes and payment can range from approximately $43 to over $141, depending on how complex a patient’s needs are.

  • A given patient can receive either regular (often referred to as “non-complex”) CCM or complex CCM during a service period if applicable (not both)
  • The difference between complex and non-complex CCM is the amount of clinical staff time, the extent of care planning, and the complexity of the problems addressed by the billing practitioner during the month

Reduced requirements associated with initiating care, and increased payment when extensive initiation work is necessary (Table 1)

  • Initiating visit only required for new patients or those not seen within a year prior to the commencement of CCM (previously all patients required an initiation visit)
  • Increased payment for CCM-related work by the billing practitioner during initiating visits (Add-On Code G0506 can be billed in addition to the initiating visit service code when the billing practitioner personally performs extensive assessment and CCM care planning beyond the usual effort for the initiating visit code)

Significantly reduced administrative burden (reduced payment rules for billing the services, Table 2)

  • Improved alignment with CPT coding language for administrative simplicity, focus on timely sharing and availability of health information rather than use of specific electronic technology, simplified patient consent, reduced documentation rules

General supervision in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), however only CPT 99490 is payable in these settings (complex CCM is not payable) and there is no add-on code/separate payment for initiating visits

TABLE 1. SUMMARY OF 2017 CCM CODING CHANGES

*(Annual Wellness Visit [AWV], Initial Preventive Physical Examination [IPPE], Transitional Care Management [TCM], or Other Qualifying Face-to-Face Evaluation and Management [E/M])

TABLE 2. SUMMARY OF CCM SERVICES CHANGES FOR 2017

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