CCP CCM Billing & CMS Guidelines 3 — Questions and Answers
Question 1: Before initiating CCM services, Medicare requires the provider to obtain patient consent. This consent must be:
- Verbal only and noted in the chart
- Written and retained in the medical record (Correct answer)
- Obtained electronically via patient portal only
- Renewed every 90 days
Correct answer: Written and retained in the medical record
CMS requires written (or verbal with documentation) consent before billing CCM, and it must be retained in the medical record.
Question 2: A patient has two chronic conditions expected to last at least 12 months and places them at risk of acute exacerbation. This meets which core CCM eligibility criterion?
- Complex care need threshold
- Minimum chronic condition requirement (Correct answer)
- High-utilization classification
- Escalated risk stratification tier
Correct answer: Minimum chronic condition requirement
CMS CCM eligibility requires at least two chronic conditions expected to last at least 12 months or until death that place the patient at significant risk.
Question 3: A CCM-enrolled patient is hospitalized for 5 days in the middle of the billing month. Can CCM still be billed for that month?
- No; inpatient status voids the CCM claim
- Yes; inpatient days are excluded but outpatient CCM time may still meet threshold (Correct answer)
- Yes; hospital time automatically counts toward the 20-minute minimum
- No; the patient must re-enroll after discharge
Correct answer: Yes; inpatient days are excluded but outpatient CCM time may still meet threshold
Inpatient time cannot be counted toward CCM minutes, but if sufficient qualifying outpatient/non-face-to-face time exists, CCM may still be billed for that month.
Question 4: Which Medicare beneficiary cost-sharing applies to CCM services billed under 99490?
- No cost-sharing; CCM is fully covered preventive care
- Standard Part B cost-sharing (typically 20% coinsurance after deductible) (Correct answer)
- A flat $10 copay per month
- Cost-sharing is waived if the patient is dually eligible
Correct answer: Standard Part B cost-sharing (typically 20% coinsurance after deductible)
CCM is a Part B service subject to the standard 20% coinsurance after the deductible, unless the patient has supplemental coverage.
Question 5: CMS requires CCM patients to have 24/7 access to their care team. Which mechanism satisfies this requirement?
- A published office phone number during business hours
- An after-hours answering service that can access the patient's care plan (Correct answer)
- An automated voice message directing patients to the ER
- A patient portal with 48-hour response time
Correct answer: An after-hours answering service that can access the patient's care plan
24/7 access must include a way for the patient to reach a clinical staff member who can access their electronic care plan at any time.
Question 6: What is the minimum number of chronic conditions a Medicare patient must have to qualify for standard CCM billing?
- One
- Two (Correct answer)
- Three
- Four
Correct answer: Two
CMS requires at least two chronic conditions expected to last 12 months or until death to qualify for CCM under 99490 or 99491.
Question 7: If a patient revokes consent for CCM mid-month, the provider:
- May still bill for time spent before revocation that month (Correct answer)
- Cannot bill any CCM for that calendar month
- Must refund any cost-sharing already collected
- Should transfer the patient to a transitional care code
Correct answer: May still bill for time spent before revocation that month
CMS allows billing for CCM time legitimately performed before consent was revoked, as long as the minimum time threshold was met.
CCP CCM Billing & CMS Guidelines 3
Before initiating CCM services, Medicare requires the provider to obtain patient consent.
This consent must be: