Chronic Care Management Services

by  Wyn Staheli, Director of Content - innoviHealth
Jun 1st, 2021

There are many different Chronic Care Management (CCM) Services found in both the CPT and HCPCS code sets. CCM is not the same as Case Management Services in that case management has to do with “coordinating, managing access to, initiating, and/or supervising'' patient healthcare services whereas CCM services also require the patient to have a condition(s) which is expected to last at least a year or until their death. These services can be broadly grouped as follows: 

This article primarily covers the last of these —  Psychiatric Collaborative Care Management Services.

Tips:

• CLICK HERE to review CCM information by CMS. However, this MLN booklet was created in 2019 so it does not have all the new codes recently added such as G2064 or 99439.

• Only one provider may be paid CCM services in any given calendar month and it can only be either complex  (99487, 99489) or non-complex (99490, 99439, 99491). Typically CCM is billed by the primary care provider, but there are some other specialties which might provide this service. Potentially this may be a problem as you may not necessarily know if they are receiving these other services. You may wish to create a questionnaire to ask if they are receiving services from another provider/specialty, however, be aware that the patient may not know the answer to that question.

Psychiatric Collaborative Care Management Services

The Psychiatric Collaborative Care Model (CoCM) is an approach to behavioral health integration (BHI) that enhances primary care services by adding care management support and regular psychiatric inter-specialty consultation for patients with a behavioral health or substance use disorder. These services are provided by a behavioral health care manager (in consultation with a psychiatric consultant and directed by the treating physician or other qualified healthcare professional) and include the required elements as listed in the table that follows. Note that one requirement applies to both so it spans both columns.

Codes 99492-99494 may be used when billing these services in a variety of settings, depending on payer-specific policies. Code G2214, which became effective on January 1, 2021, is similar to codes 99492-99494, but may be used (if allowed by the payer) to report a shorter time period (first 30 minutes). Remember that when reporting time, be sure to find out if the payer follows CPT guidelines or Medicare guidelines regarding the reporting of time.

Tips:

• CLICK HERE to review CMS information regarding these services. It includes more comprehensive information including definitions.

• The American Psychiatric Association has published an FAQ about these services, but it doesn’t include the new G2214 for up to 30 minutes so watch for places where it states that services less than 36 minutes may not be reported as that might not be true, depending on the payer.

While CPT guidelines allow for the reporting of these services in addition to certain other chronic care management services (e.g., 99490, 99487), you still need to pay close attention to the NCCI edits as there are several services which may not be reported at the same time as these services, such as ESRD monthly services (90951-90970) or therapeutic radiology (e.g., 77261-77263). 

Tip: FindACode.com subscribers can check the NCCI edits for  a code by clicking the [NCCI Edits] bar on the code’s main information page and selecting either [Facility] or [Non-Facility].