Chronic Care Management

Overview of Chronic Care Management*

As of January 1, 2015, the Medicare Physician Fee Schedule (PFS) reimburses qualified providers for Chronic Care Management (CCM) services for Medicare beneficiaries with two or more chronic health conditions. Pharmacists can participate in CCM as clinical staff, with their services being billed incident to by a qualified provider. CCM services include five core activities:

  • Recording structured data in the patient’s health record;
  • Maintaining a comprehensive care plan for each patient;
  • Providing 24/7 access to care;
  • Comprehensive care management; and
  • Transitional care management.

CCM could be a foundational base payment mechanism for pharmacists and their prescriber partners who are collaborating on the care of a patient population. Additionally, CCM and complex CCM could provide the fee-for-service mechanism for pharmacists to be compensated for some of their services as pharmacists and physicians enter into emerging quality-based and risk-sharing payment structures.

Resources for Pharmacists:

*Overview from the American Pharmacists Association (APhA), to see their full information, please visit the site listed above.

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