CCM Billing & CMS Guidelines Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 CCM Billing & CMS Guidelines flashcards as text
CMS requires that the CCM care plan be stored in a certified EHR. Which meaningful-use certified EHR standard must the system meet?
Answer: ONC Health IT Certification Program (2015 Edition or later)
CMS specifies that CCM must be documented in an ONC-certified EHR meeting at least the 2015 Edition standard.
Which of the following is a required element of the CCM care plan?
Answer: List of all treating providers and their roles
CMS requires the care plan to include a comprehensive list of all health care providers involved in the patient's care and their roles.
Add-on code 99439 can be billed for each additional increment of non-complex CCM time beyond the first 20 minutes. What is the duration of each additional increment?
Answer: 20 minutes
CPT 99439 is billed for each additional 20 minutes of clinical staff CCM time beyond the initial 20 minutes covered by 99490.
A rural health clinic (RHC) wants to bill CCM. Under CMS rules, RHCs may bill CCM using which code?
Answer: G0511, a bundled HCPCS code for general care management
RHCs and FQHCs bill CCM using HCPCS code G0511, which is a bundled rate separate from the physician fee schedule CPT codes.
When must the initiating visit for CCM occur relative to the first month of CCM billing?
Answer: It must occur before CCM services begin if there is no pre-existing relationship
If no pre-existing relationship exists, an initiating visit (AWV, IPPE, or comprehensive E&M) is required before CCM services begin.
A care manager spends 15 minutes on care coordination for a CCM patient in January but 22 minutes in February. Which month can CCM be billed?
Answer: February only
Each calendar month is evaluated independently; February's 22 minutes meets the 20-minute threshold for 99490, but January's 15 minutes does not.
Under CMS guidelines, who is the 'billing provider of record' for CCM services provided by clinical staff?
Answer: The supervising physician or qualified NPP
CCM clinical staff activities are billed 'incident to' under general supervision of the physician or qualified NPP who is the billing provider of record.