Audit of Medicare Payments for Chronic Care Management Services at Risk of Noncompliance

OBJECTIVE

Chronic care management (CCM) is care coordination that occurs outside of a regular office visit for patients with two or more chronic conditions that: (1) are expected to last at least 12 months or until the patient dies, and (2) place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.  Effective January 1, 2015, CMS established a policy for Medicare to pay, under the Medicare Physician Fee Schedule, for CCM services rendered to enrollees whose medical conditions meet certain criteria.  From calendar year 2019 through calendar year 2024, Medicare Part B payments for CCM services increased substantially.  We will review Medicare Part B payments for CCM services that may be at risk of noncompliance with the Medicare requirement for multiple chronic conditions.

TIMELINE

• March 16, 2026
  Announced
• Today
  Office of Audit Services In-Progress
• Est FY2028
  Estimated Fiscal Year for Project Completion

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