How to Get Paid for Chronic Care Management

The Centers for Medicare & Medicaid Services (CMS) will begin paying a chronic care management fee for eligible beneficiaries in 2015. CMS’ recognition of the value of primary care and the work that goes into treating patients is applauded.  This new revenue could have a significant impact on your practice’s bottom line.

To help you take advantage of this new benefit on behalf of your Medicare patients, the AAFP has published an article titled Chronic Care Management and Other New CPT Codes in the latest edition of Family Practice Management.
The article speaks to patient eligibility; practice standards; and coding, billing, and documentation procedures.  They go on to define patient eligibility, for Medicare payment purposes, as patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. CMS has not specified or otherwise limited the eligible chronic conditions that meet this definition.

As they worked to develop a set of standards for physicians to follow, CMS decided not to propose an additional set of standards but to emphasize that certain requirements are inherent in the scope of CCM services and must be met to bill for those services.  The scope of services includes:

  • Access to care management services 24 hours a day, 7 days a week.
  • Continuity of care.
  • Care management for chronic conditions, including the following:
    • Systematic assessment of a patient’s medical, functional, and psychosocial needs,
    • System-based approaches to ensure timely receipt of all recommended preventive care services,
    • Medication reconciliation with review of adherence and potential interactions,
    • Oversight of patient self-management of medications.
  • Creation of a patient-centered care plan document to ensure that care is provided in a way that is congruent with patient choices and values.
  • Management of care transitions between and among health care providers and settings.
  • Coordination with home- and community-based clinical service providers.
  • Enhanced opportunities for a patient and any relevant caregiver to communicate with the provider regarding the beneficiary’s care.
  • Electronic capture and sharing of care plan information.

CCM services will be subject to the usual cost sharing (i.e., deductible and coinsurance) for Medicare patients.

On Tuesday, January 27 the AAFP will host a webinar which will offer a more detailed look at CMS’s chronic care management fee. Registration now at this link:;jsessionid=abcQav5KsJJKsgu-3OpRu