For several years, Medicare and other payers have paid for chronic care management (CCM) services when at least 20 minutes of clinical staff time within a calendar month has been spent in care management activities. Current Procedural Terminology (CPT®) code 99490 is used to report these services. However, adoption of codes for complex CCM (CCCM) services (99487, 99489) has been less widespread. The Medicare Physician Fee Schedule (MPFS), which is often used by other payers in development of coverage policies, did not include CCCM as a separately paid service. As of January 1, 2017, the MPFS was revised to allow payment for codes 99487 and 99489 while continuing to provide payment for code 99490 when appropriately reported (Table 1).

Note the similarities and differences in the descriptors for CCM and CCCM. As shown in Table 1, patient eligibility for CCM and...

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