${color}[#0096ff](Frequently Asked Questions about Physician Billing for Chronic Care Management Services)

| This FAQ Document has been updated by MediCCM with Additional CPT Codes added to CMS Billing CCM Care Programs since 2015 - Original Document: CMS - Payment for CCM Services FAQ

This document answers frequently asked questions about billing chronic care management (CCM) services to the Physician Fee Schedule (PFS) under CPT codes (CCM) 99487, 99489, 99490 ** and other Billable CPT Codes

The CCM codes describe time spent per calendar month by “clinical staff.” Who qualifies as “clinical staff”? If the billing physician (or other billing practitioner) furnishes services directly, does their time count towards the clinical staff time required to bill CCM?

Practitioners should consult the CPT definition of the term “clinical staff.” In addition, time spent by clinical staff may only be counted if Medicare’s “incident to” rules are met such as supervision, applicable State law, licensure and scope of practice. Of course, other staff may help facilitate CCM services, but only time spent by clinical staff can be counted. If the billing practitioner provides the clinical staff services themselves, the time of the billing practitioner may be counted as clinical staff time.

**

Question 2

BHI FAQs

Accepted Answer

January 3, 2018

${color}[#0096ff](Frequently Asked Questions about Billing Medicare for Behavioral Health Integration - BHI Services)

| This FAQ Document has been updated by MediCCM for CMS Billing BHI Care Programs since 2018 - Original Document: CMS - Behavioral Health Integration FAQs

This document answers frequently asked questions about billing behavioral health integration (BHI) services to the Physician Fee Schedule (PFS). Beginning January 1, 2017, four new Medicare Part B billing codes are available to report BHI services furnished to beneficiaries during a calendar month service period. As of January 1, 2017, Medicare makes separate payments to physicians and non-physician practitioners for BHI services they furnish to beneficiaries over a calendar month service period. Beginning January 1, 2018, these services will be reported using new CPT codes. CPT codes 99492, 99493, and 99494 will be used to bill for services furnished using the Psychiatric Collaborative Care Model (CoCM). CPT code 99484 (General BHI) will be used to bill services furnished using other BHI models of care.

For patients with multiple chronic conditions, including behavioral health conditions, how should one decide when to bill chronic care management (CCM) services versus BHI services?

As noted in the CY 2017 PFS final rule (81 FR 80233, 80247)

Frequently Read Articles

Browse All Categories