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care offices. While this ‘gain’ may not be visible on the “bottom-line,” identifying patients with such co-morbidities and high-risk health issues will ultimately allow providers to address these concerns prior to conditions worsening, thus saving the organization, CMS, and the patient this potential cost (Department of Health and Human Services, 2016). In preparation for the implementation of a Chronic Care Management program, organizations must be aware of the several considerations and caveats of CCM billing and reimbursement. While the average Medicare payment allowance for CCM codes is approximately $42 per month (dependent on geographical location), CMS outlines several exclusionary criteria that may limit billing – regardless of the credentials of the care manager. According to Moore (2015), transitional care management, home health care, hospice care, and services for the care of end-stage renal disease cannot be concurrently billed during the same calendar month as CCM services. Moore (2015) highlights that this is due to the potential overlap in care management performed by all of these patientcare encounters and perceived as a form of double-billing by CMS. According to the Centers for Medicare & Medicaid Services (2016), patients must have an Annual Wellness Exam or face-to-face visit with the billing provider within the calendar year prior to the initiation of CCM. This visit is considered the “initiating visit” and only billable under physicians or NPP’s, not auxiliary staff. Additionally, this initial visit may not be billed in in combination with a CCM CPT code, but may be used to explain the services, enroll the patient, and have him or her sign consent for participation. This office visit could be an Annual Medicare Wellness Exam (which pays approximately $111) or a similarly complex level of service. New billing codes introduced in 2017 – intended to increase the maximum reimbursement by CMS for CCM services – offer an “add-on” code to be billed during the initiating-visit. Code G0506 ...