Decoding the Proposed Changes to Medicare’s Chronic Care Management (CCM)

doctor_patient_picture.jpgAs the need for solutions to America’s chronic disease epidemic only grows more pressing, Medicare’s CCM program reimburses doctors for helping patients to better manage their multiple chronic conditions.

In the year and a half since Medicare deployed the Chronic Care Management program, doctors have increasingly been taking advantage of the new reimbursement code (CPT Code 99490) to generate additional revenues while working to improve patient outcomes. As the program continues to show promise for positive change, early adopters are eager to see changes to the code that expand CCM services and reduce barriers to implementation. In an answer to our pleas, CMS recently announced proposed changes to its Physician Fee Schedule that will expand CCM beginning in 2017.

Here’s a quick review of CPT Code 99490 as it currently exists:

Screen_Shot_2016-07-24_at_5.56.35_PM.pngSource: Department of Health & Human Services Centers for Medicaid & Medicare Services

Payment for CCM is currently limited to Code 99490, but CMS has proposed new codes that would take effect in 2017 and expand access to CCM services. The code changes are outlined below in a handy reference table:


Some additional modifications to CCM are described below.

  • Simplification of Patient Consent
    Modifications now allow providers to document verbal patient consent within their medical record, rather than requiring a written agreement. This will simplify the consent process for all parties.

  • Relaxing face-to-face CCM initiation visit 
    CCM services must currently be initiated as part of a comprehensive E/M visit, Annual Wellness Visit (AWV) or Initial Preventive Physical Examination (IPPE). The proposed modification will make this in-person visit a requirement for CCM service initiation ONLY if the patient is new to the practice or has not been seen in the previous year. Clinicians providing CCM through a third-party service provider will find it much less burdensome to enroll patients in CCM thanks to these changes.

  • Care plan access
    Changes will relax the requirement of providing patients with 24/7 access to a care plan, now requiring that electronic sharing of care plan information be "timely" rather than 24/7. New allowance of transmission of care plan by fax will also make it easier to transfer care plans between providers.

Article adapted from the CY 2017 Medicare Physician Fee Schedule Proposed Rule with comment period on the CMS website.