Chronic Care Management

Service Description

Chronic Care Management (CCM) Service Clinical staff directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; Comprehensive Care Plan established, implemented, revised, or monitored.