Chronic Care Management Care Plan

(Last Updated On: March 1, 2019)

Creation and maintenance of a comprehensive, electronic care plan is required for providers billing CPT 99490. According to the Center for Medicare and Medicaid Services (CMS), the patient-centered care plan should be congruent with the patient’s choices/values and be:

“Based on a physical, mental, cognitive, psychosocial, functional and environmental (re)assessment and an inventory of resources and supports; a comprehensive care plan for all health issues… a full list of problems, medications, and medication allergies in the EHR must inform the care plan.”

Chronic Care Management care plans must be electronic. In their CY 2015 Physician Fee Schedule Final Rule, CMS outlined the requirements around the accessibility of the electronic care plan:

“Accessible to all practitioners within the practice, including being accessible to those who are furnishing care outside of normal business hours, and that is available to be shared electronically with care team members outside of the practice.”

In other words, the electronic CCM care plan must be available 24/7. This is often achieved through a cloud-based, HIPAA-compliant Chronic Care Management platform that can be accessed by providers anywhere and at anytime.