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CHRONIC CARE
MANAGEMENT

Chronic Care Management

Embracing a unified approach for telehealth, remote patient monitoring, and chronic care management to improve patient outcomes

WHAT IS CHRONIC CARE MANAGEMENT?

For patients on Medicare who are dual-eligible (Medicare and Medicaid) and live with two or more chronic conditions that worsen their quality of life and put their health at risk, chronic care management (CCM) services can help connect the dots to improve a patients’ overall quality of life. Examples of these chronic conditions include—but are not limited to—arthritis, cancer, depression, diabetes, and high blood pressure.

Provider Services include:

  • At least 20 minutes a month of care coordination from a health care professional outside of in-person office visits, such as phone check-ins and access to a secure electronic patient portal.
  • Provider coordination of care between your pharmacy, specialists, testing centers, hospitals, and more.
  • Access to a qualified healthcare professional and expert assistance with setting and meeting your health goals.

Chronic Care Management

  • Bulk Upload or API support to onboard patients
  • Obtain patient consent electronically
  • Easily assign Bluetooth, Cellular vitals measuring devices to patients
  • Set complex warnings and alerts for each patient
  • Escalate patients requiring additional care
  • Automatically generate CPT reports for reimbursement

CMS BILLING CODES

List of Medicare Telehealth Services effective January 1, 2024

CHRONIC CARE MANAGEMENT

Monthly Billing
Care Management 99490 Care Management 994391 Care Management 99439
20 Minutes $61.56 20 Minutes $47.15 20 Minutes $47.15
  • Client Staff interactions with patient and caregivers
  • Review of patient chart
  • Manage Alert and escalations
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