Skip to Main Content
LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


Impact

Print | Bookmark | Email | Font Size: + |

February 14, 2022

Chronic Care Management (CCM) for Providers in Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

The Chronic Care Management (CCM) services program provides comprehensive care management for the patient with multiple chronic medical conditions. These services extends beyond the routine office visit care. CCM services allow the health care provider and the patient/ caregivers to work together in the management of the patient’s chronic medical conditions.

Eligibility requirements for beneficiaries
To enroll, the patient must have two or more chronic medical conditions that:

  • Are expected to last at least 12 months or until death of the patient
  • Place the patient at a significant risk of death, acute exacerbation/decompensation, or functional decline

Chronic Care Management Services are part of the beneficiary’s Medicare Part B benefits. The beneficiary may need to pay a monthly fee for CCM services. The beneficiary’s Medicare Part B deductible and coinsurance apply. If the beneficiary has supplemental insurance, it may help cover this monthly cost.

Eligibility criteria for providers
Chronic care Management allows the health care provider to be paid separately while providing care to the beneficiary. To qualify to bill for Chronic Care Management services, the health provider must be classified as one of the following:

  • Physician
  • Physician Assistant
  • Certified Nurse Midwife
  • Certified Nurse Specialist
  • Nurse Practitioner

The billing health care provider should provide at least 20 minutes of CCM services per calendar month. This care can be personally provided by the health care provider or provided by clinical staff under the direction of the billing health care provider.

Start of Care requirements
Beneficiary consent needs to be obtained either during or after the initiating visit and prior to starting or billing Chronic Care Management services. Consent needs to be either completed by or under the direct supervision of the FQHC or RHC primary care provider.

  • The beneficiary consent can be verbal or written.
  • It must be documented in the medical record and include information on the availability of the Chronic Care Management services, any cost sharing involved, notification that only one health care provider can provide and bill for Chronic Care Management services per calendar month, and information about the right to stop Chronic Care Management services at any time (to be effective at the end of the calendar month). Beneficiary consent should also include information informing the patient about permission to consult with relevant specialists.

The health care provider can start the patient on CCM services if it has been determined that the patient qualifies.

  • If the patient has not been seen by the health care provider within one year prior to starting Chronic Care Management services or is a new patient, the FQHC or RHC health care provider is required to perform a face-to face visit to start Chronic Care Management services.
  • This face-to face visit can be an Annual Wellness Visit, Initial Preventative Physical Exam, Transitional Care Management, or any other qualifying face-to-face visit with the billing health care provider.
  • It is separately billed as a FQHC or RHC visit.

Billing for Chronic Care Management services in Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC)
The HCPCS code G0511 is used when billing when billing for CCM services in FQHCs/RHCs.

  • HCPCS code G5011 is defined as Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) only, general care management, 20 minutes or more of clinical staff time for Chronic Care Management services or behavioral health integration services directed by an RHC or FQHC practitioner at (physician, NPO, PA, or CNM) per calendar month.
  • Requirements for CCM services in FQHC/RHC include:
    • At least 20 minutes of care coordination (CCM) services per calendar month.
    • Provided under the direction of the billing FQHC/RHC health care provider.
    • Delivered by the FQHC/RHC healthcare provider or by the FQHC/RHC clinical staff under the general supervision of the billing FQHC/RHC health care provider.
  • The health care provider should ensure that the documentation in the patient's medical record supports that the patient is at significant risk of death, acute exacerbation/decompensation, or functional decline due to chronic medical conditions.
  • The CCM services may bill HCPCS code G0511 once every 30 days if all requirements for CCM services are met.
  • Please note- FQHCs/RHCs cannot bill HCPCS code G0506- Comprehensive assessment of and care planning for patients requiring chronic care management services

Starting with the calendar year 2022 and going forward, health care providers at RHCs and FQHCs may provide and bill for CCM, TCM, and other care management services for the same beneficiary during the same service period as long as all requirements for billing each code are met.

For more detailed information regarding eligibility requirements, benefits of Chronic Care Management, and CCM documentation requirements, please refer to CGS Chronic Care Management for ProvidersPDF.

Resources
For further information, please refer to the following:

References

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © 2025 CGS Administrators, LLC. All Rights Reserved