Chronic Care Management Changes for 2017

Chronic Care Management Changes for 2017

Medicare has finalized its proposed changes for Chronic Care Management or CCM reimbursement in 2017. Many Orb Health customers and non-customers alike have asked us what it will mean for their practices or health systems. The bottom line is that there is even more opportunity to expand revenue and serve your patients. Of course those practices using Orb Health will be able to quickly take advantage of the new codes as it will be an automatic upate to the platform.

Here are the key high-level changes for 2017:

Enrolling patients in CCM no longer requires a face-to-face visit for existing patients that have been seen by your practice in the last year. However, it’s important to remember that new patients or those that have not been seen within the last year still require an initiating face-to-face visit.

Separate consent forms are no longer required. However, documentation of acceptance must exist and include the following acknowledgements: cost sharing, requirements that only one physician can bill for CCM, notification that the patient may stop the service at any time, and clear designation on whether the patient accepted or declined services.

New reimbursement codes have been added by CMS for additional care plans. See below for more details.

You can see the entire CMS announcement with full details on the changes by clicking on this press release link. For Orb Health clients, the changes will be automatically included in our platform updates so that you can easily take advantage of the new reimbursement codes and enrollment options beginning January 2017. We will continue to monitor the rollout of these updates and notify you of any important modifications.

Read on for a deeper look at newly added 2017 CPT codes to learn more about complex-CCM and care plan billing opportunities:

CPT code 99487 – Complex chronic care management services with the following required elements:  Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; Establishment or substantial revision of a comprehensive care plan; Moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

  • Reimbursement:  +/- $85.00 per patient per month     RVU:  1.00

CPT code 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month and must also involve complex or moderately complex decision making.  (List separately in addition to code for primary service).

  • Reimbursement:  +/- $30.00 per patient, per month     RVU: .50

New Add-on G-Code G0506 Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed separately from monthly care management services) (Add-on code, list separately in addition to primary service).  

  • Reimbursement:   +/- $68.00 The G-Code may be billed once per patient.      RVU: .87