Providing and Billing Medicare for Chronic Care Management and Related Services

Medicare began reimbursing physicians for chronic care management (CCM) services in January 2015 under CPT® 994901 in response to anecdotal evidence that care management services reduce the total costs of care and improve patient outcomes. In November 2017, the Centers for Medicare & Medicaid Services’ (CMS) evaluation contractor, Mathematica, published its analysis2 of CCM’s impact on Medicare spending from 2014 to 2016. The results were impressive: per-beneficiary-per-month (PBPM) expenditures decreased by $74 for CCM beneficiaries after 18 months. Most of these savings were realized in inpatient and post-acute care, while Medicare payments to physicians actually increased.

In February 2019, Mathematica published its qualitative study of Medicare beneficiaries’ experience with chronic care management, finding that “patients reported multiple benefits of participating in CCM services, including better access to their primary care team, improved continuity of care, and improved care coordination.” These findings make a compelling case for CCM for providers participating or preparing to participate in risk-based contracts. As CMS noted in the 2020 Medicare Physician Fee Schedule Final Rule, CCM is “increasing patient and practitioner satisfaction, saving costs, and enabling solo practitioners to remain in independent practice.” By 2019 (the most recent year for which Medicare utilization data is available), those numbers had grown to 24,000 physicians and non-physician practitioners, 4.3 million CCM services, and 1 million Medicare beneficiaries.