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Published March 9, 2021

PYA White Paper Simplifies Medicare Billing Rules for Chronic Care Management Services

PYA’s chronic care management white paper includes changes for 2021 and helps providers navigate complex Medicare billing rules.

PYA has released an updated white paper, “Providing and Billing Medicare for Chronic Care Management Services.” The white paper includes new guidance from the 2021 Medicare Physician Fee Schedule Final Rule (Final Rule).

While data from the Centers for Medicare & Medicaid Services show an increase in the utilization and billing of chronic care management (CCM) services since 2015 (when these services were introduced), only a small percentage of eligible beneficiaries receive CCM. This is due, in part, to providers’ concerns regarding reimbursement. It is estimated that two-thirds, or 35 million individuals using Medicare have multiple chronic conditions; however, less than 10% of beneficiaries have received these services.

“PYA’s 2021 white paper includes updates to CPT© codes and national payment rates and helps providers navigate Medicare billing rules for reimbursement, enabling more providers to participate in CCM,” said PYA Principal Martie Ross. “The Q&A format allows providers to easily find information regarding beneficiary eligibility, care plan development, practice capabilities, staffing, supervision, service requirements, documentation, and claims submission for CCM.”

PYA first published its CCM white paper in 2015, when CMS began reimbursing physicians for these services. As CMS has updated billing rules and expanded reimbursement, PYA has updated this resource on which numerous providers have relied in developing their CCM programs. 

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