CCM Billing & CMS Guidelines Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 CCM Billing & CMS Guidelines flashcards as text
CPT code 99491 differs from 99490 in that it requires the billing provider to personally perform at least how many minutes of CCM services?
Answer: 20 minutes
CPT 99491 requires the physician or qualified NPP to personally perform at least 20 minutes of clinical staff or direct CCM time per calendar month.
Which CPT code is used to bill for each additional 20 minutes of complex CCM services beyond the first 60 minutes?
Answer: 99489
CPT 99489 is the add-on code for each additional 30 minutes of complex CCM time beyond the initial 60 minutes billed under 99487.
Under CMS rules, which of the following services CANNOT be billed on the same day as a CCM service by the same provider?
Answer: Transitional Care Management (TCM)
CCM cannot be billed during the same month a TCM service is billed because TCM time counts toward CCM and the services overlap.
Medicare's CCM benefit requires that a care plan be based on a physical, mental, cognitive, psychosocial, functional, and environmental assessment — known collectively as what?
Answer: Comprehensive care plan
CMS requires a comprehensive care plan that addresses all domains listed and is electronically shared with other treating providers.
A CCM patient calls the practice at 8 PM on a Friday with a non-urgent question. The care coordinator spends 7 minutes answering. How does this time count for billing?
Answer: It counts toward the monthly CCM time log
All non-face-to-face clinical time related to CCM, including after-hours calls, counts toward the monthly time log as long as it is documented.
Under complex CCM (99487), the minimum required time of clinical staff CCM services per calendar month is:
Answer: 60 minutes
CPT 99487 requires at least 60 minutes of clinical staff time per calendar month for complex CCM patients requiring moderate or high decision-making.
CMS specifies that only ONE provider per patient per month may bill CCM. If a patient's PCP is billing CCM and a cardiologist also wants to bill, what should happen?
Answer: The cardiologist cannot bill CCM for the same patient that month
CMS only allows a single billing provider to submit CCM for a given patient in a given calendar month; the other provider's time may be incorporated but not separately billed.