According to Medicare, “Complex Chronic Care Management services of less than 60 minutes in duration, in a calendar month, are not reported separately. Practitioners must report CPT 99489 in conjunction with CPT 99487. They must not report CPT 99489 for care management services of less than 30 minutes along with the first 60 minutes of Complex Chronic Care Management services during a calendar month.”

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1
What is Complex Chronic Care Management – All you
need to know
www.healthviewx.com

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The Centers for Medicare & Medicaid Services (CMS) considers Chronic Care Management (CCM)
as a crucial part of primary care. Chronic Care Management is non-face-to-face care provided to
Medicare patients with two or more chronic conditions. It contributes to better health services to
people. In 2015, Medicare started to reimburse a certain amount for the Chronic Care Management
services under the Medicare Physician Fee Schedule (PFS).
Medicare Chronic Care Management Program

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● CPT 99487 – Complex chronic care management services with the following required elements:
○ Multiple (two or more) chronic conditions expected to last at least 12 months, or until the
death of the patient
○ Chronic conditions place the patient at significant risk of death, acute exacerbation, or
functional decline
○ Establishment or substantial revision of a comprehensive care plan
○ Moderate or high complexity medical decision-making
○ 60 minutes of clinical staff time directed by a physician or other qualified care provider,
per calendar month
Service Code CPT 99487

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● CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other
qualified care provider, per calendar month (List separately in addition to code for primary
procedure)
Service Code CPT 99489

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Difference between CCM and Complex CCM
CCM (“non-complex” CCM) and complex CCM services have similar health service
elements. They differ in the following aspects,
● Amount of clinical staff service time provided
● Involvement and work of the billing practitioner
● The extent of care planning performed
According to Medicare, “Complex Chronic Care Management services of less than 60
minutes in duration, in a calendar month, are not reported separately. Practitioners
must report CPT 99489 in conjunction with CPT 99487. They must not report CPT
99489 for care management services of less than 30 minutes along with the first 60
minutes of Complex Chronic Care Management services during a calendar month.”

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Eligibility Criteria for Care Providers
Physicians and the following non-physician practitioners may bill CCM services:
● Certified Nurse Midwives
● Clinical Nurse Specialists
● Nurse Practitioners
● Physician Assistants

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Patient Eligibility
Medicare provides Chronic Care Management services for patients with multiple (two
or more) chronic conditions
● Expected to last at least 12 months or until the death of the patient
● Places the patient at significant risk of death, acute exacerbation/
decompensation, or functional decline
As Chronic Care Management services have reimbursements, physicians must
consider administering CCM to the eligible Medicare patients. The billing practitioner
cannot report both complex and regular (non-complex) CCM for a given patient for a
given calendar month. In other words, a given patient receives either complex or non-
complex Chronic Care Management services during a given service period, not both.

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The Complex CCM codes (CPT 99487, 99489) come under the general supervision according to
Medicare PFS. A billing practitioner need not give the health service personally. Any qualified care
provider can give the service under the billing practitioner’s overall direction and control. The billing
practitioner’s physical presence is not required.
Supervision

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The following are steps through which a Chronic Care Management service is furnished,
1. Initiating Visit – Initiation during an Annual Wellness Visit (AWV), Initial Preventive Physical
Examination (IPPE) or face-to-face E/M visit for new patients or patients not seen within one
year prior to the commencement of Chronic Care Management services.
2. Structured Recording of Patient Information Using Certified EHR Technology – Structured
recording of demographics, problems, medications, and medication allergies using certified
EHR technology.
CCM Service Summary

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3. 24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified
healthcare professionals or clinical staff and continuity of care with a designated member of the
care team.
4. Comprehensive Care Plan – Creation, revision, and/or monitoring of an electronic person-
centered care plan.
5. Enhanced Communication Opportunities – Enhanced opportunities for the patient to
communicate with the physician through not only telephone access, but also the use of secure
messaging, Internet, or other non-face-to-face consultation methods.
CCM Service Summary

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Features of HealthViewX CCM Software

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1 Automated call log feature
After a call, care plan creation or any action related to CCM health services,
the system automatically adds call logs. It reduces the physician’s manual
effort is logging the call logs.

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Preventive Care Plans
2
HealthViewX solution supports care plans for the Chronic Care Management
service for a patient. The physician can create a care plan depending on the
patient’s health report. It helps in monitoring the patient’s vitals.

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Chronic Care Management
Analytics3
Dashboards with intuitive charts and tables give complete analytics of the
Chronic Care Management services. It provides a clear picture of the revenue
perspective

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4 Consolidated Reports
The physician can generate a consolidated report of the Chronic Care
Management services given for a particular period. This makes it easy for
the billing practitioner for getting the Medicare reimbursements.

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HIPAA Compliance
5
HealthViewX Chronic Care Management is HIPAA compliant. It facilitates
secure data exchange. The solution manages all patient-related documents
securely.

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HealthViewX Care Management and Chronic Care
Management solutions have features that suit
healthcare organizations best.
To know more about our solutions, schedule a
demo at www.healthviewx.com
Schedule a Demo with HealthViewX

18. Email: marketing@healthviewx.com
Phone: +1 (214)-461-0242Contact us anytime.
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