Do Medicare Advantage Plans Pay For CCM Services?


CMS addressed whether physicians could bill for chronic care management (CCM) services provided to Medicare Advantage plan members using the CCM code implemented on Jan. 1 2015.

In summary:

  • Medicare Advantage plans already provide care coordination.
  • Physicians treating patients enrolled in such plans cannot bill for services using the CCM code unless the contract between the Medicare Advantage plan and the physician specifically provide for such coverage.
  • If a patient enrolled in a Medicare Advantage plan chooses an out-of-network physician to provide CCM services, then that physician can bill for those services using the CCM code.

Fee-for-service-plans, as well as PACE plans( -- also referred to as Programs of All-Inclusive Care for the Elderly -- are not coordinated care plans and therefore must cover all Medicare A and B services, including the CCM code.

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Cambridge, MA