What is Chronic Care Management (CCM)?
The Centers for Medicare & Medicaid Services (CMS) recognizes that care management is a critical component of primary care that promotes better health and reduces overall health care costs. On January 1, 2015, CMS began paying separately for non–face-to-face care coordination services furnished to Medicare beneficiaries who have two or more chronic conditions that are expected to last at least 12 months (or until the death of the patient).
Through CPT code 99490, family physicians and other eligible health care professionals can be reimbursed by CMS for providing chronic care management (CCM) services to their patients. Examples of covered services include phone calls and emails to a patient to discuss management of chronic conditions, management of referrals to other providers, management of prescriptions, and ongoing review of patient status.
The Academy's Position on CCM
The Academy's advocacy efforts helped pave the way for CPT code 99490. Medicare reimbursement for CCM gives family physicians an opportunity to be paid for the many services they provide outside of traditional face-to-face office visits. The Academy believes that family physicians should be compensated for the value they bring to their patients by delivering continuous, comprehensive, and connected health care.
What Members Need to Know
Medicare beneficiaries who qualify for CCM services benefit from additional support and resources that help them manage their chronic conditions effectively. More coordinated care leads to better health and decreased overall health care costs. As the health care system transitions from a fee-for-service model to value-based payment, billing CPT code 99490 makes it possible for you to be paid for the time and effort you and other care team members invest in caring for your patients who have chronic conditions.
Learn More About CCM with the AAFP CCM Toolkit
Want to be reimbursed for providing CCM services? The Academy's Chronic Care Management Toolkit includes the following resources to help you get started:
- A step-by-step CCM implementation guide for a successful launch
- Easy-to-use CCM calculator with financial model to determine starting expenses
- Q&A highlighting important CCM implementation requirements and red flags
- Easy to understand CCM introduction talking points for health care team
- Front-desk staff and support staff CCM talking points
- CCM handout for beneficiaries, highlighting program requirement and benefits
- CCM consent form for patients who agree to receive services
- A personalized care plan template to help patients take actions and meet their heath goals