This resource is part of the AMA's Debunking Regulatory Myths series, supporting AMA's practice transformation efforts to provide physicians and their care teams with resources to reduce guesswork and administrative burdens.
The Centers for Medicare and Medicaid Services (CMS) requires patient consent to be obtained at regular intervals for Chronic Care Management (CCM).
CMS does not require physicians, other clinicians, or health care organizations to obtain patient consent for CCM on a regular, recurring schedule. Patient consent (verbal or written) is only necessary before the start of CCM services and if the patient changes to a new billing practitioner for these services. In the latter scenario, the new practitioner is responsible for obtaining patient consent before providing CCM services.1 Whether patient consent to receive CCM services is obtained in a written or verbal manner, it must be documented in the electronic medical record.2
CCM includes patient care coordination services such as care planning, care management, help with transitions of care, and support with achieving health goals while prioritizing continuity of care. CCM services are delivered by a care team led by a physician or other Licensed Independent Practitioner (LIP) and are typically conducted outside of regular office visits.
Eligible patients have two or more chronic conditions expected to persist for at least 12 months or until their death which place them at increased risk of acute exacerbation and/or decompensation, functional decline, or death. Physicians, physician assistants, clinical nurse specialists, nurse practitioners, and certified nurse midwives may bill for CCM monthly if the services continue.2,3
- CMS FAQs: Practitioner Billing for CCM Services. Accessed June 2023.
- September 2022 CMS Medicare Learning Network Booklet: CCM Services. Accessed June 2023.
- Download this myth: Chronic Care Management Consent (PDF)
- CMS. Frequently Asked Questions About Practitioner Billing for Chronic Care Management Services. Published online August 16, 2022. Accessed June 30, 2023. https://www.cms.gov/files/document/chronic-care-management-faqs.pdf
- CMS. Chronic Care Management Services. In: Medicare Learning Network Booklet.; 2022:1-15. Accessed June 30, 2023. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf
- CMS. Chronic Care Management and Connected Care. CMS. Published March 30, 2023. Accessed June 30, 2023. https://www.cms.gov/about-cms/agency-information/omh/downloads/ccm-toolkit-updated-combined-508.pdf
Visit the overview page for information on additional myths.
Disclaimer: The AMA's Debunking Regulatory Myths (DRM) series is intended to convey general information only, based on guidance issued by applicable regulatory agencies, and not to provide legal advice or opinions. The contents within DRM should not be construed as, and should not be relied upon for, legal advice in any particular circumstance or fact situation. An attorney should be contacted for advice on specific legal issues.