Patients need to have two or more “chronic” conditions to qualify for Chronic Care Management. A chronic condition can be defined as a condition that:
- Is expected to last at least 12 months, or until the death of the patient
- Places the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
There is no strict list of qualifying conditions – a condition just has to meet the above two criteria. The CMS Chronic Conditions Data Warehouse is a good, non-exhaustive starting point for qualifying conditions:
| CMS Chronic Condition Warehouse Chronic Conditions | |
| Acquired Hypothyroidism | Chronic Kidney Disease |
| Acute Myocardial Infarction | Chronic Obstructive Pulmonary Disease |
| Alzheimer’s Disease | Depression |
| Alzheimer’s Disease, Related Disorders, or Senile Dementia | Diabetes |
| Anemia | Glaucoma |
| Asthma | Heart Failure |
| Atrial Fibrillation | Hip / Pelvic Fracture |
| Benign Prostatic Hyperplasia | Hyperlipidemia |
| Cancer, Colorectal | Hypertension |
| Cancer, Endometrial | Ischemic Heart Disease |
| Cancer, Breast | Osteoporosis |
| Cancer, Lung | Rheumatoid Arthritis / Osteoarthritis |
| Cancer, Prostate | Stroke / Transient Ischemic Attack |
| Cataract | |
Again this is a non-exhaustive list – even conditions such as Obesity may qualify if they meet the two criteria.
