Checklist: Chronic care management (CCM)
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation requests for chronic care management (CCM) services. It is not intended to replace the published guidelines. Health care providers retain responsibility to submit complete and accurate documentation. Additional tools and interactive score sheets are available to assist you on our website under our Evaluation and Management section.
| Check |
Documentation description |
|---|---|
| Documentation is for the correct beneficiary and date of service. |
|
| Documentation is complete, legible, signed and dated by the physician or clinician. |
|
| Documentation includes evidence of a comprehensive care plan being established, implemented, revised or monitored. |
|
| Documentation includes evidence of the beneficiary has two or more chronic conditions expected to last at least 12 months, or until death of the beneficiary. |
|
| Documentation includes evidence that the chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. |
|
| Total time spent providing chronic care management services for the month is documented. |
|
| Evidence of an initiating visit for new patients or those not seen within one year prior to starting CCM services. |
|
| Documentation includes evidence of patient consent prior to initiation of CCM services. Consent may be verbal or written. |
|
| Documentation reflects that the patient was informed of the availability of CCM services and applicable cost‑sharing. |
|
| Documentation reflects that only one practitioner furnished and billed CCM services for the patient during the calendar month. |
|
| Documentation notes the patient's right to stop CCM services at any time, effective at the end of the calendar month. |
|
| Documentation shows the patient and/or caregiver received a copy of the care plan or has electronic access to it (e.g., patient portal). |
|
| If applicable, a beneficiary waiver of liability is included. |
Disclaimer
This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation requirements published in national or local coverage determinations, or the CMS documentation guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of documentation.