Benefits available for chronic care management and advance care planning services effective February 23, 2019

Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. are committed to investing in primary care, rewarding coordinated, patient-centered care, and promoting proactive chronic care management. In recognition of the time-intensive nature of this work, Anthem will reimburse chronic care management and advance care planning services for members enrolled in our Anthem PPO and Anthem HealthKeepers (non-Medicaid) commercial health plans effective for claims processed on or after February 23, 2019.

 

- Chronic care management (CCM) is care rendered by a physician or non‐physician health care providers and their clinical staff, once per calendar month, for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. Only one practitioner can bill a CCM service per service period (month). Three CCM codes are included in this payment policy change:  99490, 99487and 99489.

 

- Advance care planning (ACP) is a face-to-face service between a physician or other qualified health care professional and a patient discussing advance directives with or without completing relevant legal forms. An advance directive is a document in which a patient appoints an agent and/or records the wishes of patients pertaining to their medical treatment at a future time if patients cannot decide for themselves at that time.  No specific diagnosis is required for the ACP codes to be billed. It would be appropriate to report a condition for which you are counseling the beneficiary. Two ACP codes are included in the payment policy change: 99497 and 99498

 

Anthem requires patient consent prior to CCM or ACP service(s) being provided. Please refer to your current contract booklet for the Claims Requiring Additional Documentation policy for more information. If you have questions about your contract booklet, contact your Anthem network manager.