2017 CCM Reimbursement Changes

The LATEST Q&A  directly from CMS on CCM Reimbursement Changes – Click here for the OFFICIAL document.

Medicare has made changes to CCM reimbursement in 2017.  The bottom line is they’ve made it easier to enroll patients and added new reimbursements.   We’ve bulleted the high level changes below and encourage you to connect to the official CMS links added just below the bullet points for full and complete information.

Enrolling patients in CCM no longer requires a face to face visit for existing patients that have been seen in the last year. New patients or those not been seen in the last year still require an initiating visit.

  • Separate consent forms are no longer required. However, documentation of acceptance must exist and include:  cost sharing, that only one physician can bill for CCM, patient may stop the service at any time and whether they accepted or declined services.
  • Additional reimbursement of $68 under G code G0506 is now available upon creation of the patient’s care plan. See below
  • Additional reimbursements are provided for CCM patients of moderate and high complexity that involve additional time. See below.  (Note:  CCM 99490 did not require moderate or high complexity)
  • 24 x 7 Care CMS changed the 24/7 access language to be for ‘urgent’ needs rather than ‘urgent chronic care needs.’

Link to CMS announcement: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-02.html

Link to Federal Register, Department of Health and Human Services, Centers for Medicare and Medicaid, Revisions to Payments.  See Page 311 to view Table 11:  Summary of CY 2017 Chronic Care Management Service Elements and Billing Requirements  https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26668.pdf

New CCM codes approved for 2017

Link to CMS Official Guide

CPT code 99487 – Complex chronic care management services with the following required elements:  Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;  Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; Establishment or substantial revision of a comprehensive care plan; Moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

Reimbursement:  +/- $94.00 per patient per month     RVU:  1.00

CPT code 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month and must also involve complex or moderately complex decision making.  (List separately in addition to code for primary procedure).

Reimbursement:  +/- $47.00 per patient, per month     RVU: .50

New Add-on G-Code G0506 Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed separately from monthly care management services) (Add-on code, list separately in addition to primary service).  

Reimbursement:   +/- $64.00 The G-Code may be billed once per patient.      RVU: .87