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Supported Line of Business: Medicare Advantage
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The below does not cover billing for Complex Chronic Care Management
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Chronic Care Management (CCM) services were established by CMS in the CY 2015 Physician Fee Schedule (PFS) Final Rule and became billable starting January 1, 2015. CCM is designed to support Medicare patients with multiple chronic conditions through ongoing care coordination, care plan development, medication management, and between-visit communication.
CCM services are typically provided as incident-to services by clinical staff under the general supervision of a billing practitioner. The billing practitioner remains responsible for establishing, implementing, revising, and monitoring the patient’s comprehensive care plan.
There are no standalone National or Local Coverage Determinations (NCDs/LCDs) specific to CCM - the policies are governed primarily through the annual PFS final rules and the Medicare Benefit Policy Manual.
To qualify for CCM, a patient must have:
There are multiple types of CCM services, distinguished by complexity and time requirements:
Chronic Care Management (CCM – Non-Complex):
Requires ≥ 2 qualifying chronic conditions and at least 20 minutes of clinical staff time per calendar month directed by a physician or other qualified health care professional. A comprehensive care plan must be established and maintained.
Complex Chronic Care Management (Complex CCM):
Requires ≥ 2 qualifying chronic conditions with moderate- to high-complexity medical decision making, and at least 60 minutes of clinical staff time per calendar month. Documentation must support increased care coordination complexity. Bridge does not support Complex CCM at this time.
Add-On CCM Time:
Additional time increments may be billed when monthly time thresholds beyond the base code requirements are met.