CCP CCM Billing & CMS Guidelines 5

Question 1

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

Accepted Answer

Hospice care

Answer

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

Question 2

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

Accepted Answer

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

Answer

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

Question 3

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

Accepted Answer

Only one complex chronic condition

Answer

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

Question 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?

Accepted Answer

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

Answer

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

Question 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?

Accepted Answer

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

Answer

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

(CCP) Chronic Care Professional Certification Practice Test

(CCP) Chronic Care Professional Certification Practice Test

CCP CCM Billing & CMS Guidelines 5