Chronic Care Management Services

June 1st, 2021 - Wyn Staheli, Director of Research
Categories:   Coding   CPT® Coding   Skilled Nursing   Home Health|Hospice  
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There are many different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death. These services can be broadly grouped as follows: 

Category

Description

Codes

Chronic Care Management Services (CCM)

Patients have two or more chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline

99490, 99439 [replaced G2058], 99491

Complex Chronic Care Management Services (CCM)

Patients meeting criteria of chronic care management who ALSO have medical, functional, and/or psychosocial problems requiring medical decision making of moderate or high complexity

99487, 99489

Principle Care Management Services (PCM)

Patients who have a single high-risk disease of sufficient severity to place the patient at risk of hospitalization or have been the cause of recent hospitalization

G2064, G2065

Psychiatric Collaborative Care Management Services (CoCM)

Patients who have behavioral health signs and/or symptoms or a newly diagnosed behavioral health condition

99492, 99493, 99494

Notes:

  • PCM services have a shorter time frame than other categories. The condition is expected to last between 3 months and 1 year or until death of the patient.
  • G0506 is an add-on code which may be used with another Evaluation & Management (E/M) service (e.g., 99202-99205) to account for the work of initiating CCM services. It may only be billed once, at the onset of CCM services if allowed by the payer.
  • G0511 and G0512 may ONLY be used by Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) for CCM.

This article primarily covers the last of these —  Psychiatric Collaborative Care Management Services.

Tips:

  • CLICK HERE to review CCM information by CMS. However, this MLN booklet was created in 2019 so it does not have all the new codes recently added such as G2064 or 99439.
  • Only one provider may be paid CCM services in any given calendar month and it can only be either complex  (99487, 99489) or non-complex (99490, 99439, 99491). Typically CCM is billed by the primary care provider, but there are some other specialties which might provide this service. Potentially this may be a problem as you may not necessarily know if they are receiving these other services. You may wish to create a questionnaire to ask if they are receiving services from another provider/specialty, however, be aware that the patient may not know the answer to that question.

Psychiatric Collaborative Care Management Services

The Psychiatric Collaborative Care Model (CoCM) is an approach to behavioral health integration (BHI) that enhances primary care services by adding care management support and regular psychiatric inter-specialty consultation for patients with a behavioral health or substance use disorder. These services are provided by a behavioral health care manager (in consultation with a psychiatric consultant and directed by the treating physician or other qualified healthcare professional) and include the required elements as listed in the table that follows. Note that one requirement applies to both so it spans both columns.

Initial

Subsequent

Tracking patient follow-up and progress using the registry, with appropriate documentation

Patients have two or more chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline

Outreach to and engagement in treatment of patient by physician/QHP

Ongoing collaboration with and coordination of the patient's mental health care with the treating physician/QHP and other treating mental health practitioners

Initial assessment including administration of validated rating scales and development of individualized treatment plan

Monitoring of patient outcomes using validated rating scales

Psychiatric consultant reviews the plan and makes modifications as necessary

Psychiatric consultant reviews progress and makes recommendations for changes in treatment, as indicated, including medications

Providing brief interventions via evidence-based techniques (e.g., motivational interviewing)

 

Participation in weekly caseload consultation with the psychiatric consultant.

Relapse prevention planning with patients as they achieve remission of symptoms and/or achieve other treatment goals and are prepared for discharge from active treatment

Codes 99492-99494 may be used when billing these services in a variety of settings, depending on payer-specific policies. Code G2214, which became effective on January 1, 2021, is similar to codes 99492-99494, but may be used (if allowed by the payer) to report a shorter time period (first 30 minutes). Remember that when reporting time, be sure to find out if the payer follows CPT guidelines or Medicare guidelines regarding the reporting of time.

Tips:

  • CLICK HERE to review CMS information regarding these services. It includes more comprehensive information including definitions.
  • The American Psychiatric Association has published an FAQ about these services, but it doesn’t include the new G2214 for up to 30 minutes so watch for places where it states that services less than 36 minutes may not be reported as that might not be true, depending on the payer.

While CPT guidelines allow for the reporting of these services in addition to certain other chronic care management services (e.g., 99490, 99487), you still need to pay close attention to the NCCI edits as there are several services which may not be reported at the same time as these services, such as ESRD monthly services (90951-90970) or therapeutic radiology (e.g., 77261-77263). 

Tip: FindACode.com subscribers can check the NCCI edits for  a code by clicking the [NCCI Edits] bar on the code’s main information page and selecting either [Facility] or [Non-Facility]. 

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Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


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