CPT Codes for each program you’re managing for the patient
ICD-10 codes tied to each of the conditions you’re managing within that program
Date of service
Place of service
While it’s not needed, it is helpful to know the care manager assigned to a patient in case you’re ever audited: When billing, you’ll calculate the time spent with each of your patients monthly.
These are the four steps you’ll take when billing:
Verify CMS requirements were met for each patient each month
Submit claims to CMS monthly
Send an invoice to patients receiving CCM services monthly
Make sure there are no conflicting codes that have been billed
CPT Codes for Chronic Care Management
CPT codes for chronic care vary depending on who provides the service, as well as its complexity. Each code reflects a different value and the amount of time dedicated to care management.
In the following section, we break down the various types of billing codes for CCM.
CPT Codes for Non-complex Chronic Care Management
For the reimbursement of non-complex chronic care by clinical staff, the following rates apply. They are based on national averages, which may vary by the locality:
For rural health clinics (RHCs) and federally qualified health clinics (FQHCs), the following CPT code for "general care management" would apply for CCM.
When billing for chronic care services, you must present two ICD-10s (as CCM requires two or more conditions to be present).
You can only bill for one series of CCM services per patient, per month. For example, you can only submit a claim for either non-complex CCM or complex CCM. Not both.
CPT Codes for Physician-driven, Non-complex Chronic Care Management
CCM services are not reliant on clinical staff; some physicians are more hands-on than others.
The following billing codes were created to reflect the value of these physicians’ time.
They are for non-complex chronic care, where the provider or non-physician practitioner (NPP) is heavily involved. They cannot be billed concurrently with standard CCM CPT codes.
For non-complex care driven by the physician, you would use the following billing codes: CPT Codes for Complex Chronic Care Management
For complex care, the following billing codes apply:
It is important to note that CPT code 99487, which accounts for 60 minutes of complex chronic care, differs from 60 minutes of non-complex CCM service. The distinction is clear. But it’s key to utilize the correct code when providing complex care.
In the case of an audit by Medicare, you’ll want to show the correct code was applied based on the situation. Some providers have run into trouble by failing to bill the accurate code.
What is the ROI of a Chronic Care Management Program?
While the phrase return on investment (ROI) holds a financial connotation, a “return” isn’t entirely dependent on monetary value. General benefits are equally important, especially with regard to a person and their health.
Your patients will benefit from CCM because it places a preventive eye on their health.
As for CCM reimbursement rates, what is the revenue opportunity of the program?
The final figure in the graphic does not account for complex or physician-driven CCM services. Nor does it include additional billable time beyond the 20-minute minimum. Both could produce a higher figure.
Offering a CCM program can generate revenue, and it can recover costs and broaden care access for your patients. The combination is inherently valuable.
Streamline CCM With Care Coordination Software
To deliver and document CCM services, you’ll want a system in place to manage your program.
A practical resource, such as care coordination software, will keep key details from being lost or overlooked. This will promote efficiency for you and your staff and help patients succeed. Care coordination software can streamline the creation of patient care plans, support staff workflows, and simplify billing. ThoroughCare’s software solution offers these exact features.
With a clinician’s eye, we’ve designed an intuitive platform that untangles the entire CCM process, so you and your patients can capitalize on it. Our care coordination software solution enables you to offer a whole suite of wellness services that pair well with CCM, such as Behavioral Health Integration (BHI) or Remote Patient Monitoring (RPM).