Patients with two or more chronic diseases qualify for CCM services. For an individual physician with 200 patients who qualify, the original CCM CPT code 99490 can generate monthly revenue of $42 per patient per month for non-face-to-face care services. At 200 patients per month, this equates to monthly revenue of $8,400 and yearly revenue of $100,800. This additional revenue compensates providers for activities that are often already being performed by staff.

In addition to the primary CPT code 99490, new codes were introduced in January 2017 which create new revenue opportunities for providers.

CPT code 99490 allows eligible care providers to bill for at least 20 minutes of non-face-to-face clinical staff time each month to coordinate care for patients with two or more chronic conditions.

• Revenue: $42/20 minutes

CPT code 99487 requires substantial revision of a care plan, moderate or high complexity medical decision making, and 60 minutes of clinical staff time.

• Revenue: $93/60 minutes

CPT code 99489 is a complex CCM add-on code to 99487 for each additional 30 minutes of clinical staff time.

• Revenue: $47/30 minutes

HCPCS code G0506 is an add-on code to the CCM initiating visit for providing a comprehensive assessment and care planning to patients.

• Revenue: $63/ one time

CPT Code 99358 is a prolonged E/M service provided by a physician before and/or after direct patient care.

• Revenue: $113/ 60 minutes

CPT code 99359 is an add-on code for prolonged E/M service provided by a physician before and/or after direct patient care (listed separately with 99358).

• Revenue: $55/ 30 minutes

• Physicians

• Physicians assistants

• Nurse practitioners

• Clinical nurse specialists

• Certified nurse midwifes

In January of 2017, CCM program requirements have been modified and simplified. Written consent from the patient is no longer a requirement; consent may be obtained verbally if the physician documents in the patient record that the required program information was discussed. To begin CCM services, the Initiating Visit is no longer mandatory as long as the patient is not a new patient and has been seen within the past twelve months. Program requirements that have remained the same in 2017 include twenty minutes of non-face-to-face clinical staff time per month and a care plan that must be made available to the patient and other health care providers.

Before beginning the CCM program, the first step is to see which of your Medicare patients are eligible to participate in this program. In order to qualify for CCM, Medicare patients must have two or more chronic conditions expected to last for twelve or more months that place them at risk for decompensation, functional decline, or death. On average, an individual primary care physician will have 200 patients who qualify and the Center for Primary Care (CPC) estimates that 75% of qualified patients will agree to participate in CCM.

CMS does provide a specific list, but states that chronic conditions eligible for services include, but are not limited to:

• Alzheimer’s disease and related dementia

• Arthritis (osteoarthritis and rheumatoid)

•Asthma

• Atrial fibrillation

• Autism spectrum disorders

• Cancer

• Chronic obstructive pulmonary disease

• Depression

• Diabetes

• Heart failure

• Hypertension

• Osteoporosis

A care plan should be constructed to meet the specific needs of your patient. While there is no required format for care plan construction, there are typical components of a care plan. These components include a plan for coordination with other providers, a problem list, measurable treatment goals, symptom management, and a list of current medications and allergies. The typical components listed above may be documented through an annual wellness visit.

There are no certified technology requirements necessary for CCM documentation, however a certified EHR is required for recording clinical information, which includes problems, medications, and medication allergies.

Yes, you will be unable to bill for the services listed below in the same month CCM is billed:

• Transitional care management (TCM) services (CPT 99495 and 99496)

• Home health supervision (HCPCS G0181)

• Hospice care supervision (HCPCS G0182)

• Certain end-stage renal disease (ESRD) services (CPT 90951-90970)

An exception to these billing restrictions applies to TCM, CPT 99495 and 99496. TCM and CCM may be billed in the same month if 20 minutes of CCM services has been provided between the time TCM concluded and the final day of the calendar month.

CMS’ intent is to minimize the amount of out-of-pocket expenses for patients; however, they will still be responsible for co-payments, deductibles, and remainder balances according to their insurance agreement. If your patient is a Medicare B patient with no secondary coverage, they will be responsible for paying a monthly fee of $8.

Chronic care management (CCM) aims to improve care and outcomes for patients with chronic conditions, reduce the overall costs of patient care, and reduce avoidable hospital admissions.

Our cloud-based software, AviTracks-CM, enables you to maximize efficiency without adding overhead by automating your chronic care management workflow. Our flexible software supports your unique way of delivering care, while also adapting to the changing demands of the healthcare industry. AviTracks is designed to help you maximize your reimbursement from Medicare’s CCM program, improve patient outcomes, and reduce hospital admissions and ER visits.

AviTracks automates your entire care management workflow including enrolling the patient, creating patient-centered care plans, documenting medications, scheduling and tracking calls and other activities, and generating documentation needed for billing purposes.

AviTracks-CM is a HIPAA compliant web-based application that runs under encrypted technology, providing security for data in transit and at rest.

Additional security features include:

• Microsoft Azure cloud hosted environment

• Fully redundant data centers in the United States

• Full Chain of Business Associate Agreements

• Comprehensive suite of security technologies

• Antivirus protection

No, there is no large upfront investment to begin using AviTracks-CM. Instead, we offer an affordable monthly subscription based on the number of patients you have enrolled in your CCM program.