Medical Review Frequently Asked Questions (FAQs)

Q1. What are the documentation requirements for Chronic Care Management services (CCM)?
A1. Documentation must include the following components:

  • Include a narrative detailing need for CCM
  • Support beneficiary eligibility
  • Include a comprehensive care plan (with measurable goals) established, implemented, revised, or significantly monitored
    • Patient or caregiver must be given a copy of care plan. Medicare does not specify a certain format for care plan
  • Include CCM discussion narrative with beneficiary and his/her (verbal (for patients who have been seen in practice within past 12 months) or written) prior permission acceptance
    • Verbal acceptance must be documented and must be explained to patient for transparency
    • Beneficiary may terminate consent at any time
  • Support services rendered
  • Support provision of at least 20 or 60 minutes of CCM services for month billed (based on specific procedure code billed)
  • CCM webpage

Q2. Is a provider required to submit a consent for treatment for Chronic Care Management each time documentation is requested?
A2. Yes. A patient consent is a required element to be submitted with each Additional Documentation Request (ADR).

Q3. When is it appropriate to bill HCSPCS G0402, G0438, and G0439?
A3. View definitions below.

  • G0402 - Initial preventive physical examination (IPPE); face-to-face visit, services limited to new beneficiary during first 12 months of Medicare enrollment
  • G0438 - Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit. Only one per lifetime. After first 12 months of Part B coverage and have not had their IPPE within past 12 months
  • G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit. Eligible every 12 months after initial Annual Wellness Visit

Q4. How can a provider retrieve his/her claim comments for Part B claims?
A4. If you are a Noridian Medicare Portal (NMP) user, log into NMP

  • Select Claim Status from menu bar
  • Claim Status Inquiry page
    • Complete all Provider/Supplier Details
    • Complete all Beneficiary Details
    • Complete Claim Details
    • Click Submit Inquiry button at bottom of form
  • Claim Status Results page
    • Choose View Claim
  • On right side of page is heading Related Inquiries
    • Choose Noridian Comments
  • Scroll down page and comment will display below Claim Status Line Details

Visit the NMP webpage for portal Information.


Last Updated Jun 01, 2018