Practice Test Geeks(CCP) Chronic Care Professional Certification Practice Test
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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

  1. A CCM patient is also receiving Home Health services this month. CMS prohibits billing CCM alongside which specific type of service?

    Answer: Hospice care

    CCM cannot be billed for patients receiving hospice care because the comprehensive care management needs are included in the hospice benefit.

  2. Which best describes CMS's 'general supervision' requirement for CCM clinical staff activities?

    Answer: The physician must be available and the work must be within established protocols

    General supervision means the physician or NPP is available (not necessarily present) and clinical staff act within established scope and protocols.

  3. Principal Care Management (PCM) codes 99424–99427 were introduced as an alternative to CCM. A key eligibility difference is that PCM requires:

    Answer: Only one complex chronic condition

    PCM is designed for patients with a single, complex chronic condition requiring substantial care management, unlike CCM's two-condition minimum.

  4. If a CCM-enrolled patient has a face-to-face office visit in the same month, can that visit time be counted toward the 20-minute CCM threshold?

    Answer: No; face-to-face E&M time is excluded from CCM time

    CMS excludes face-to-face time from CCM time calculations; only non-face-to-face clinical staff activities count toward the monthly minimum.

  5. A practice uses a care coordination company to provide CCM services under a shared arrangement. What must be true for the practice to bill Medicare for these services?

    Answer: The services must be provided under the supervision of and billed by the Medicare-enrolled provider

    Third-party CCM vendors must operate under the enrolled provider's supervision, and the provider bills Medicare directly — the vendor cannot independently bill.

  6. Documentation of CCM time must be stored in the certified EHR and should include which of the following for each activity?

    Answer: The date, duration, and description of each CCM activity performed

    CMS requires that each CCM activity be documented with the date, time spent, and a description of the service to support the monthly time total.

  7. The 2024 Medicare Physician Fee Schedule expanded CCM by adding which new code for advanced primary care management?

    Answer: G0558

    CMS introduced G0558 (and related codes G0556, G0557) for Advanced Primary Care Management (APCM) in the 2025 PFS, recognizing higher-intensity primary care practices.