Chronic Care Management

According to the Center for Disease Control (CDC), about half of all adults–117 million people–suffer from one or more chronic health conditions, and one out of every four adults has two or more chronic health conditions. In fact, chronic diseases ranked seventh out of the top 10 causes of death in 2010.

The Centers for Medicare and Medicaid Services (CMS) recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending. The goal of this service is to help manage your chronic condition and lower your need for hospitalizations, although it is only available for Medicare recipients.

What defines chronic care management?
Chronic care management services are described as at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following 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.
  • Comprehensive care plan established, implemented, revised, or monitored.
  • 24/7 provider service

Source: CPT 99490

What are chronic conditions?
Chronic conditions include, but are not limited to:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial Fibrillation
  • Autism Spectrum disorders
  • Cancer
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Depression
  • Diabetes
  • Heart Failure
  • Hypertension
  • Ischemic Heart Disease
  • Osteoporosis

Chronic Care Services

  • 20+ minutes of non-face-to-face care management services
  • Access to care 24/7
  • Ability to get successive routine appointments
  • Monitoring of patient condition
  • Preventative care services
  • Medication reconciliation
  • Guidance for patient management of medications
  • Follow-up after ER visits
  • Coordination for transition of care