Medicare continues to support and encourage chronic care management (CCM) to promote better patient health and reduce costs. Revised rules over the past few years brought new payment opportunities and changes to codes for CCM. Our coding and billing guide offers essential information on the most current coding and billing changes for chronic care management, two services based on CCM — behavioral health integration and principal care management — and 2025 reimbursement rates.
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Disclaimer:
Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.
Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.
Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.
Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.
The coding options listed here are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.
Prevounce helps healthcare organizations develop and grow remote care management programs that keep patients healthy and improve financial performance. We provide a cloud-based platform, cellular-connected patient devices, and expert services that support remote patient monitoring, chronic care management, and annual wellness visits.