What elements are required to bill chronic condition management (CCM) services?

• A. Monthly documentation only
• B. A care plan and monthly documentation; consent not required
• C. Patient consent and monthly documentation only
• D. Patient consent, a care plan, and monthly documentation

Answer: (D)

Chronic care management billing hinges on three essential elements: patient consent, a documented care plan, and monthly documentation of the management activities. Consent must be obtained before starting CCM and documented in the patient’s record. The care plan should outline the patient’s chronic conditions, treatment goals, proposed interventions, and how care will be coordinated across providers. Monthly documentation is required to capture the ongoing management efforts, including the time spent (at least 20 minutes of clinical staff time directed by a physician or other qualified professional) and any updates to the care plan or communications with the patient or caregiver. The patient typically must have two or more chronic conditions that are expected to last at least 12 months. Because all three elements are required, this combination is the correct basis for billing CCM services.