Medicare billing study highlights facilitators and barriers to CCM use

The use of chronic care management (CCM) CPT codes increased over a four-year period, but physicians infrequently reported codes for complex CCM, according to findings from a review of Medicare claims recently published in the Annals of Family Medicine.

To learn more about the national trends in chronic care management use, physicians at the University of Washington School of Medicine in Seattle examined 2015-2018 Medicare data capturing 100% of CCM claims submitted to Medicare by physicians nationwide. They calculated service counts and payments for both paid and denied CCM services, and compared utilization and payment by physician specialty.

The researchers found that CCM use increased among medicine subspecialists from 60,511 services in 2015 to 448,821 in 2018. In addition, they found that primary care physicians represented 78% of CCM use over the four-year period.

Their findings show that the original CCM CPT code 99490 (CCM services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month), accounted for 93% of all CCM services, while the following codes for complex CCM services represented just 7.9% of CCM services in 2017 and 10.6% in 2018:

• CPT code 99487, complex CCM services; 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
• CPT add-on code 99489, complex CCM services; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month  
• HCPCS add-on code G0506, comprehensive assessment of and care planning for patients requiring CCM services 

These codes were introduced in 2017 to provide higher reimbursement for complex CCM.

According to the researchers, it is still unclear whether the reimbursement attached to the newer CCM codes is enough to support a clinician’s investment in developing the staff, resources, and workflows needed for care coordination.

Finally, the percentage of denied CCM services remained consistent at around 5% during this period. This may suggest administrative burden associated with billing and payment for these codes.

These findings underscore the need for additional large-scale research studies to evaluate potential payment and implementation issues associated with CCM services, according to the researchers.