CCM Qualifying Chronic Conditions

(Last Updated On: July 11, 2017)

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.