Health Care Homes
Incentives and Payments
CMS Chronic Care Management Resources
Centers for Medicare & Medicaid Services (CMS) Chronic care management (CCM) is care coordination services done outside of the regular office visit for Medicare patients with multiple (two or more) chronic conditions expected to last at least 12 months and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These services are typically non-face-to-face and allows eligible practitioners to bill for at least 20 minutes or more of care coordination services per month.
- Why CCM is Important and how CCM supports primary care (PDF) [CMS website]
- Chronic Care Management and Connected Care [CMS website]
CMS Care Management by areas of billing:
- Advanced Care Planning; Behavioral Health Integration; Chronic Care Management; and Transitional Care Management [CMS website]