Care Management Billing

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
May 26th, 2022

Chronic Care Management (CCM) is taking off, and with new codes and rules, it can get confusing. According to CMS, here are a few guidelines to help you with concurrent billing of CCM services.

• You can’t report complex CCM and non-complex CCM for the same patient in a calendar month
• Don‘t report 99491 in the same calendar month as 99487, 99489, or 99490
• You can’t bill CCM during the same service period by the same practitioner as HCPCS codes G0181 or G0182 (home health care supervision, hospice care supervision) or CPT codes 90951–90970 (certain ESRD services)
• You can report CCM codes 99487, 99489, 99490 and 99491 by the same practitioner for services furnished during the 30-day TCM service period (CPT 99495, 99496)
• You can’t report complex CCM and prolonged Evaluation and Management (E/M) services in the same calendar month
• Consult CPT instructions for other codes you can’t bill concurrently with CCM
• Other practitioner billing restrictions may apply if you’re taking part in a CMS-sponsored model or demonstration program
• You can’t count time toward the CCM service code for any other billed code
• Beginning CY 2022, RHCs and FQHCs can bill CCM and TCM services for the same patient during the same time period

These are just a few things to pay attention to. More information is coming next week.

For more comprehensive information about these services join us for our nextwebinar, "Coding 2022 Care Management Services" scheduled for Thursday, June 2, 2022 @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET. Click HERE to register for this FREE webinar.