Wiki Who needs an initiating visit before starting Chronic Care management?

[davidinasheville]

I see that an initiating visit is needed for certain patients before starting CCM (see Medicare statement below). It seems to me that the initiating visit is needed only for new patients or those not seen within the last year. Others in my practice interpret this as requiring an initiating visit for all patients (which was the rule until a few years ago). Can anyone clarify? If recently seen patients do not need an initiating visit, what should be the process for starting CCM service.? Can anyone share their protocol for this?

From Medicare May 2024: Initiating Visit. Before CCM services can start, we require an initiating visit for new patients or patients who the billing practitioner hasn’t seen within the previous 1 year. The initiating visit can happen during a comprehensive face-to-face evaluation and management (E/M) visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE). If the practitioner doesn’t discuss CCM during an E/M visit, AWV, or IPPE, it can’t count as the initiating visit. A face-to-face initiating visit isn’t part of CCM and can be separately billed. Practitioners who personally provide extensive assessment and care planning outside the usual effort described by the initiating visit and CCM codes may also bill HCPCS code G0506 once, as part of an initiating visit.

Thanks

David Clements

 

[rthomas@impcna.com]

I see that an initiating visit is needed for certain patients before starting CCM (see Medicare statement below). It seems to me that the initiating visit is needed only for new patients or those not seen within the last year. Others in my practice interpret this as requiring an initiating visit for all patients (which was the rule until a few years ago). Can anyone clarify? If recently seen patients do not need an initiating visit, what should be the process for starting CCM service.? Can anyone share their protocol for this?

From Medicare May 2024: Initiating Visit. Before CCM services can start, we require an initiating visit for new patients or patients who the billing practitioner hasn’t seen within the previous 1 year. The initiating visit can happen during a comprehensive face-to-face evaluation and management (E/M) visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE). If the practitioner doesn’t discuss CCM during an E/M visit, AWV, or IPPE, it can’t count as the initiating visit. A face-to-face initiating visit isn’t part of CCM and can be separately billed. Practitioners who personally provide extensive assessment and care planning outside the usual effort described by the initiating visit and CCM codes may also bill HCPCS code G0506 once, as part of an initiating visit.

Thanks

David Clements

The CCM initiation needs to be done by the provider (MD, DO, NP, PA) that will be providing CCM services. Our providers do this during the patient's chronic disease appt or AWE.