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CCM is the care coordination that is outside of the regular office visit 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 or decompensation, or functional decline. According to estimates from the Centers for Medicare & Medicaid Services, one in four adults, including 70% of Medicare beneficiaries, have two or more chronic health conditions, qualifying them for CCM.
Medicare began paying for CCM services separately under the Physician Fee Schedule (PFS) in 2015. Practitioners may now bill for CCM for a calendar month when at least 20 minutes of non-face-to-face clinical staff time, directed by a physician or other qualified health care professional, is spent on care coordination for a Medicare patient with multiple chronic conditions. This time may be spent on activities to manage and coordinate care for eligible patients.
Alzheimer’s disease and related dementia • Arthritis (osteoarthritis and rheumatoid) • Asthma • Atrial fibrillation • Autism spectrum disorders • Cancer • Cardiovascular disease • Chronic Obstructive Pulmonary Disease • Depression • Diabetes • Hypertension • Infectious diseases such as HIV/AIDS • Substance Use Disorders
If you have 2 or more serious chronic conditions (like arthritis and diabetes) that you expect to last at least a year, Medicare may pay for a health care provider’s help to manage your care for those conditions.
After you meet the
Part B deductible, you pay coinsurance for these services.
Chronic care management includes:
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