Chronic Care Management (CCM)

What Is Chronic Care Management?

Chronic care management (CCM) is a program available to you if you’re on Medicare and have at least two long-term (chronic) health conditions. You must expect these conditions to last for at least 12 months or until your death.

With CCM, the U.S. Centers for Medicare & Medicaid Services (CMS) pays for a healthcare provider to manage your care. CMS allows your provider to offer healthcare services outside the office setting. Your provider helps you follow your care plan, manage your conditions and prevent future issues. (In Florida, these encounters are all over the phone.)

CMS provides this benefit because it promotes better overall health. It helps you prioritize self-care and reduces the costs of healthcare. If you have multiple health conditions, managing them can feel overwhelming. Chronic care management can help simplify your care.

What services does chronic care management provide?

Chronic care management includes personalized medical care from a dedicated healthcare provider. (In Florida, the provider will be a registered nurse.) Your provider will help you create a care plan and support you in achieving your health goals. They’ll keep track of your medical records and do regular reviews of your health status. Other chronic care management services include:

• 24/7 access to care
• Coordination of care with specialists, pharmacists and other providers
• Support when going to a new healthcare facility
• Information about community resources
• Symptom management
• Medication management
• Preventive care (to help prevent new health issues)
• Self-care tips and support
• Interventions to reduce falls

Who is eligible for chronic care management?

To qualify for chronic care management (CCM), you must have Medicare or be dually eligible (Medicare and Medicaid). You must also have two or more long-term (chronic) medical conditions that:

• Put your health at risk
• Decrease your quality of life
• Are expected to last for at least 12 months or until your death

At your initial visit, you must also give written or verbal informed consent. This confirms that you’re involved in your medical care and aware of any shared costs.

What conditions qualify for chronic care management?

Many different long-term (chronic) health conditions qualify for chronic care management. Examples include, but aren’t limited, to:

• Alzheimer’s disease
• Arthritis
• Autism
• Cancer
• Chronic kidney disease
• Chronic obstructive pulmonary disease (COPD)
• Depression
• Diabetes
• Heart failure
• High blood pressure
• Stroke
• Substance use disorder

Which types of healthcare providers can offer chronic care management services?

Any qualified member of the clinical staff can perform CCM services. But only certain healthcare providers can supervise care and bill Medicare for the services. These providers include:

• Physicians
• Clinical nurse specialists
• Nurse practitioners
• Physician assistants
• Certified nurse midwives

What are chronic care management CPT codes?

Healthcare providers use Current Procedural Terminology (CPT®) codes to bill Medicare for the CCM services they offer. The five chronic care management CPT codes are:

How much does Medicare pay for chronic care management?

Chronic care management is a Medicare Part B service. Medicare pays 80% for all Part B services. You may be responsible for the 20% coinsurance. If you have Medicare and Medicaid (dual eligible), you may be fully covered. Other people have a private policy (Medigap) that covers the 20% not covered by Medicare.

Is chronic care management worth it?

Many people find value in chronic care management. The program helps you manage your care and offers support as you work toward your health goals. Other chronic care management benefits include:

• Personal attention from your healthcare provider
• Frequent communication between you and your provider
• Reduction in falls, declining health and trips to the ER
• More time to spend focusing on the things you love