Remember not all patients require the initiating visit. For CCM it is patients that are new or not seen within the last 12 months.
It has to have documentation of the discussion of CCM services to count as initiating visit. We have and autophrase that states " Discussed chronic care management, as a service and preferred method to manage their medical needs. Referral to CCM Care Team has been placed. "
Some of my providers will obtain consent and we have them document the following: "The patient agreed to be enrolled and begin CCM Services. All parts of CCM Services were discussed in detail with the patient/caregiver. Patient/caregiver is aware of and indicated verbal understanding of the following: 1)The benefits of CCM Services and methods of enhanced care team contact; 2) As needed, we will securely share the patient’s health information electronically with others involved in their care; 3) We will bill their insurance for the CCM services once a month, provided 20 minutes of non-face-to-face care for the patient and patient’s conditions, and there is a possibility of co-pay or coinsurance; 4) Only one provider may bill for this service in a given month; AND 5) The patient can discontinue the service at any time for any reason by notifying the care team member, who will provide them with an end of service date."
We also have the nurses verify this consent on their first contact with the patient to make sure they don't have any additional questions.
You can have an initiating visit without billing G0506, but cannot bill G0506 without the initiating visit.If you're billing G0506 - one would expect to see the documentation of the comprehensive assessment and care plan with goals. As that is what this code is designed to cover -the effort above the initiating visiting requirements in performing a comprehensive assessment and care planning.
According to PYA White Paper on CCM: "CMS has clarified that the date of service for G0506 should be the same
as the base initiating-visit code. The face-to-face assessment should be
performed the same day as the initiating visit, although CMS recognizes that
some, or all, care planning could be completed on a subsequent day." For their full paper on Care Management see the link here:
https://www.pyapc.com/insights/pya-white-paper-2025-update-on-medicare-billing-rules-for-care-management/Addie Lowe, RN, MSN
Chronic Care Manangement and Pre-Visit Planning Team Lead
Covenant Medical Group
Cell:
843-372-2334Email:
atomlin2@covhlth.com<mailto:
atomlin2@covhlth.com>
Get Outlook for iOS<https://aka.ms/o0ukef>
Disclaimer
This E-mail contains PRIVILEGED AND CONFIDENTIAL INFORMATION intended only for the use of the Individual(s) named above. If you are not the intended recipient of this E-mail, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination or copying of this E-mail is strictly prohibited. If you have received this E-mail in error, please immediately notify us at (865)374-4900 or notify us by E-mail at hdesk@covhlth.com.
Original Message:
Sent: 3/11/2025 8:54:00 AM
From: Leslie McDowell
Subject: RE: Chronic Care Management (CCM) - Initiating Visit Documentation
The language in the MLN booklet under the 'Initiating Visit' section reads 'Before CCM services can start, we require an initiating visit....'
My interpretation of that language is that if CCM services have not yet started, a comprehensive care plan has not yet been established.
(I am not a billing professional.)
------------------------------
Leslie McDowell ANP-BC DNP RN
Northwest AHEC/Wake Forest Univ Sch of Med
Winston Salem NC
(336) 972-7852
ANP-BC DNP RN
------------------------------
Original Message:
Sent: 03-07-2025 10:15
From: Amanda Spicer
Subject: Chronic Care Management (CCM) - Initiating Visit Documentation
Good Morning,
I was reviewing the CCM Initiating Visit Requirements on the CMS MLN Booklet. It states that the initiating visit can happen during a comprehensive face-to-face E/M Visit, Annual Wellness Visit, or IPPE. The provider must inform and document the Availability of CCM Services, Possible Cost Sharing, Only 1 Practitioner Can Provide/Bill CCM, Patient's Right to Stop CCM Services, and whether the patient accepted or declined services.
Does the provider need to document any pieces of the Comprehensive Care Plan in their note during the initiating visit?
Thank you,
------------------------------
Amanda Spicer, MSN, RN, NPC-BC
Director of Patient Care & Internal Resources
Parkview Physicians Group
Fort Wayne, IN
Amanda.Spicer@parkview.com
(260) 425-6497
------------------------------