Do you know that chronic care services are the known non-face-to-face services bestowed to the Medicare beneficiaries who have chronic conditions from at least the last 12 months or until the patients’ death?
The Centers for Medicare and Medicaid services identify that chronic care management services are an essential component of primary care, which further endorse better health and lessen healthcare costs.
Eligibility of the Practitioners
Look at the practitioners who may be physicians or non-physicians can bill the CCM services, i.e., Certified Nurse Midwives, Clinical Nurse Specialists, Nurse Practitioners, and Physical Assistants. There may be the case that only a single practitioner might be paid for the CCM services for a provided calendar month. Moreover, this practitioner should report either complicated or non-complicated CCM for a provided patient for the month.
The practitioners might bill CCM many times, and in some specific circumstances, the specialty practitioners might deliver and bill for chronic care services. The chronic care services are not at all within the scope of practice of reserved license physicians. The practitioners like clinical psychologists, dentists, and practitioners might cite or consult with the physicians and the practitioners to better coordinate and manage everything at one’s end.
The Billable time for face to face activities
The CCM indulges the kind of activities that are not ordinarily furnished face to face with the healthcare beneficiary and others like reviewing medical records, telephone communication, test results, coordination, and exchange of the health information with other practitioners and providers. Previously, for the separate payment for CCM, the specific activities were included in the charge for the face-to-face visits. We refer to them as non-face to face actions because they are present in general. If such activities occasionally provide face to face for convenience or many other reasons, the time might be counted towards CCM service codes. The CCM also indulges the activities like patient education, counseling for motivation, which is frequently provided to the patients either in person or non-face to face. If some practitioners have faith in a given beneficiary, it would benefit or engage more and recommends a beneficiary to acquire specific CCM services in person. The thing is, they can still count the activity as the billable time. Merging all the cases, the time and effort cannot count towards other codes if counted towards CCM.
For the new patients or the patients who haven’t seen within a year before the onset of the CCM, Medicare needs the initiation push of the CCM services while face-to-face visit with the billing practitioner or other face to face visits with the billing practitioners. Moreover, this initiating visit is not part of CCM service and is billed on an individual basis.
Look at the practitioners who endow a CCM triggering visit and perform the excessive assessment and CCM care planning outside of the common efforts described by the triggering visit code. It may bill HCPCS code G0506, a comprehensive assessment of the care planning by the physician or qualified health care professional for patients needing chronic care management services. It is billed individually from monthly care management services, add-on code, a separate list in the inclusion of the primary service. This code is reportable per every CCM practitioner and in conjunction with the CCM triggers.
For CPT 99490
The chronic care management services for at least 20 minutes of clinical staff directed by the physician or other qualified health care professional per calendar month with the much-needed elements:
- It goes with multiple chronic situations, which is expected to last at least 12 months or until the Patient’s death time.
- The chronic conditions place the patients at particular death risk, acute exacerbation/decompensation, or functional decline.
- The comprehensive established, implemented, revised, or monitored care plan.
It takes 15 minutes of work by the billing practitioner by month.
For CPT 99491
Chronic care management services are bestowed personally by a physician or different other qualified health care professional. It takes at least 30 minutes of physician or other qualified health care professional per calendar month with the much-needed elements as following:
- The multiple chronic conditions that are expected to last at least 12 months or till the death of the Patient.
- These chronic conditions put the Patient at specific risk of death, acute exacerbation/decompensation, or some functional decline.
- It includes the comprehensive, established, implemented, revised, monitored care plan.
For CPT 99487
It brings the complex chronic care management services with a few of the needed elements:
- It has multiple chronic conditions expected to last at least 12 months or until the patients’ death.
- The chronic conditions have their patients at risk of death with the acute exacerbation/decompensation or functional decline.
- The generation or the substantial revision of the comprehensive care plan.
- It consists of moderate or high complexity medical decision making.
- It’s 1 hour of the clinical staff time, which is directed by a physician or qualified health care professional for a single calendar month.
For CPT 99489
Every extra 30 minutes of the clinical staff time is directed by the physician or other qualified health care professional per calendar month.
The complicated CCM services of less than 1 hour in a calendar month duration are not reported individually. The report 99489 is in conjunction with the 99487. Don’t report 99489 for care management services of lower than 30 minutes in addition to the first 1 hour of complicated CCM services during a calendar month.
CCM, also referred to as the non-complex CCM and the complex CCM services, share a widespread set of service elements. These actually vary in the amount of clinical staff service time delivered, the billing practitioner’s involvement and work, and the extent of the performance of the care planning.
You know physicians and the following non-physician practitioners might bill CCM services, which are:
- Certified Nurse-Midwives
- Clinical Nurse Specialists
- Nurse Practitioners
- Physician Assistants
You know that the CCM might be billed frequently by the primary care practitioners and although in specific situations, the practitioners might provide and bill for CCM. The CCM service is not within the scope of the licensed physicians’ practice, and the practitioners like clinical psychologists might refer or consult other physicians and practitioners to well-coordinate and manage care.
The CPT code 99491 indulges the time which is spent personally by the billing practitioner. The clinical staff time would not be counted towards the needed time threshold for reporting the code.
The CPT codes 99487, 99489, and 99490 have the time spent directly by the billing practitioner or the clinical staff counts on the threshold clinical staff time needed to be spent during a provided month. The CCM services that aren’t provided personally by the billing practitioner are actually provided by the clinical staff under the billing practitioner’s direction on an incident basis, subject to applicable state law, licensure, and scope of the practice. The clinical staff can be the employees or the people working under the contract to the billing practitioner to whom Medicare directly pays for CCM.
What does the supervision say?
The CCM codes which describe the clinical staff activities (CPT 99487, 99489, and 99490) are linked to the general supervision under the Medicare PFS. The general supervision simply means when the billing practitioner does not personally perform the service. It is performed under the overall direction and control, and the rest of the physical presence is not needed.
The Patient’s eligibility
The patient has multiple chronic conditions expected to last for at least 12 months or until the patients’ death. The place the Patient at the risk of death, acute exacerbation/ decompensation, or functional decline comes under the legibility criteria for CCM services.
The Billing practitioners might consider recognizing patients who need CCM services with the help of the criteria suggested in the CPT guidance like illness, number of medications, repetitive admissions, emergency department, or the profile of the typical patients in the CPT prefatory language. There is also a big requirement to lessen the geographic and racial/ethnic disparities in health via CCM services provision. It also provides several resources for recognizing and engaging the subpopulations to aid in lessening the disparities.
Chronic conditions can include:
- Alzheimer’s Disease and Dementia
- ATRIAL fibrillation
- Autism spectrum disorders
- Cardiovascular disease
- Chronic obstructive pulmonary disease
- Infectious diseases like HIV/AIDS.
The chronic care services are extensive, including the structured recording of the patient’s health information, which also maintains a comprehensive electronic care plan. It also helps in managing the transitions of the care and several; other care management services. It also indulges in coordinating and sharing the patient health information timely within and outside of the practice. The 24/7 patient access to the health and care information, receipt of the preventive care, the engagement of the patients and the caregivers, and time-sharing and use of the health information make the CCM services work out of the box.