Q. Under the
Medicare Chronic Care Management (CCM) Services program, can my practice
subcontract CCM services to a case management company? What if the clinical
staff the case management company employs is located outside the United States?
You may arrange to have clinical staff external to your practice, such as a
case management company, provide CCM services if you meet all the “incident to”
and other rules for billing Medicare for these services. However, because there
is a regulatory prohibition against payment for nonemergency Medicare services
furnished outside the United States, you can’t bill Medicare for CCM services
if they’re provided to patients or by individuals located outside the country.
If you use
an outside management company, you, as the billing physician, still must
initiate the CCM during a “comprehensive” evaluation and management (E&M)
visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE).
This face-to-face visit is not part of the CCM service, and
you can bill Medicare for it separately, but it’s required before you can
provide CCM services directly or under other arrangements. You must discuss CCM
with the patient at this visit, and while you don’t have to obtain informed
patient consent during this visit, it is an opportunity to do so.
The face-to-face visit included in transitional care
management (TCM) services (CPT 99495 and 99496) qualifies as a “comprehensive”
visit for CCM initiation. Levels 2 through 5 E&M visits (CPT 99212 through
99215) also qualify. However CPT codes that don’t involve a face-to-face visit
by the billing physician or are not separately payable by Medicare (such as CPT
99211, anticoagulant management, online services, telephone, and other E&M
services) do not meet the requirement for the visit that must occur before you
furnish CCM services. If you furnish a “comprehensive” E&M, AWV, or IPPE
but don’t discuss CCM with the patient at that visit, that visit can’t count as
the initiating visit for CCM.
See more answers in the Centers for Medicare & Medicaid
about billing Medicare for CCM. This is one of many resources on CMS’ new Care Management webpage that covers advance care planning, CCM, and
Published Feb. 7, 2017
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Last Updated On
November 22, 2019