Who may bill Medicare for Chronic Care Management?

Physicians, as well as clinical staff working under their supervision, may provide chronic care management services.

To furnish and bill for CPT 99490 / G0511, providers must act within their Medicare statutory benefit, and state licensure.

Chronic Care Management services are most commonly billed by primary care physicians, and specialty physicians who meet all of the billing requirements may bill Medicare for CCM. CCM may be not be within the scope of practice for some practitioners such as dentists, podiatrists, or clinical psychologists.

  • Physicians
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants
  • Certified Nurse Midwives

It is important to keep in mind that only one practitioner may bill for CCM for an individual patient in any given month.1

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Our consultants can help you determine if CCM is a viable option for your practice.

1 Under Medicare’s “incident to” rules, there is an exception proved by CMS that allows clinical staff to provide chronic care management services under the general (as opposed to direct) supervision of a physician or other eligible practitioner.

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