Chronic Care Management for Providers
Which providers can bill for CCM services?
●Physicians and Physician specialists (General Doctors, Cardiologist, Neurologist, Pulmonologist, etc.)
●Certified nurse midwives (CNMs)
●Clinical nurse specialists (CNSs)
●Nurse practitioners (NPs)
●Physician assistants (PAs)
Primary care practitioners typically bill for CCM services, though some specialists may also do so. Limited-license practitioners like clinical psychologists, podiatrists, and dentists cannot bill for CCM but may be involved in care coordination. Clinical staff, as employees or contractors, can provide CCM services under the billing practitioner's direction on an "incident to" basis, following state laws and licensure rules. Payments go directly to the billing practitioner.
What do we provide for your patients?
● Assess the patient’s medical, functional, and psychosocial needs
● Make sure the patient gets timely recommended preventive services
● Review medications and any potential interactions
● Oversee the patient’s medication self-management
● Coordinate care with home- and community-based clinical service providers
● Communicate with home- and community-based providers about the patient’s psychosocial needs and functional decline, and document it in the patient’s medical record
● Complete access to patient’s HIPAA compliant private portal through the SimplePractice app where you can coordinate with the case manager and access records from other outside providers
● Request orders or services that you would like for the case manager to transcribe, organize, or carry out
● A necklace with dog tags, wallet card, or bracelet with a built in USB drive to carry all of your records on you at all times in case of emergency or if your loved one is found unconsious
How is chronic care management billed and reimbursed?
ULM Solutions charges healthcare providers a fee based on monthly patient care minutes. CCM services are reimbursed by insurance with no monthly limits on minutes with a minimum of 20 minutes per month per patient, provided the provider submits case manager documentation justifying the care. Please check with your billing specialist to determine reimbursement rates in your area.
These are the CPT codes that we follow under the Physician Fee Schedule, Medicare will pay for:
CPT code 99487
Complex CCM, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
CPT code 99489
Add-on code for CPT code 99487 for each additional 30 minutes of clinical staff time
CPT code 99490
CCM services, first 20 minutes of clinical staff time directed by a physician or other qualified health professional, per calendar month
CPT code 99439
Add-on code for CPT code 99490 for each additional 20 minutes of clinical staff time
How do I initiate services for my patients?
CCM services require an initiating visit for new or long-unseen patients (over 1 year). CCM services must be discussed during any evaluation and management (E/M) visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE) to qualify as the initiating visit. You must get the patient’s written or verbal consent before billing for CCM services and ensure that they understand:
●The availability of CCM services
●Their possible cost sharing responsibilities
●That only 1 practitioner can provide and bill CCM services during a calendar month
●The patient’s right to stop CCM services at any time (effective at the end of the calendar month)
●That the practitioner explained the required information and whether the patient accepted or declined services