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