Who Qualifies for Chronic Care Management Services

by  Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
March 5th, 2020

Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services."

Examples of chronic conditions include, but are not limited to, the following:

     ● Alzheimer’s disease and related dementia
     ● Arthritis (osteoarthritis and rheumatoid)
     ● Asthma
     ● Atrial fibrillation
     ● Autism spectrum disorders
     ● Cancer
     ● Cardiovascular Disease
     ● Chronic Obstructive Pulmonary Disease
     ● Depression
     ● Diabetes
     ● Hypertension
     ● Infectious diseases such as HIV/AIDS

NOTE: Do not report a complex and non-complex session in the same calendar month. 

References:

• MLN- Chronic Care Management Services