The Federal Register on July 15th released the Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release; Medicare Advantage and Part D Medical Low Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model.

This 856-page document provides new direction for the Chronic Care Model reimbursement incentives through Medicare. Highlights from the Federal Register include:

  • Initiating visit for enrollment is required only for new patients or patients who have not been seen within or evaluated within one year;
  • Beneficiary consent can be obtained without a written agreement between patient and provider;
  • Removing the requirement for 24/7 access to care plan by CCM providers;
  • Now paying for two related CCM codes (99487 & 99489) for “complex” services 99487: 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month;
  • 99489: Additional 30 minutes of clinical staff time per calendar month;
  • Removing the requirement to standardize content for the continuity of care document;
  • New “add-on G-code” to add payments for provider led care planning;
  • General Supervision allowed for rural health clinics and FQHCs (vs. Direct Supervision)

These changes are designed to speed service adoption and reduce the administrative burden. The CCM codes 99487 and 99489 are used to recognize the increased time required for some beneficiaries who require “complex” services above and beyond the 20 minutes, and these codes will provide for additional reimbursement.