What conditions qualify for Chronic Care Management (CCM)?
To be eligible for Medicare's Chronic Care Management (CCM) services, individuals are required to have at least two chronic conditions. The following is a rundown of key conditions recognized by the Centers for Medicare & Medicaid Services (CMS) as qualifying for CCM, though this list is not all-inclusive. It is advisable for patients whose conditions are not explicitly mentioned to consult with their healthcare providers to determine if they are eligible for CCM services.
Cardiovascular and Blood Conditions:
- Hypertension
- Ischemic heart disease
- Heart failure
- Stroke/transient ischemic attack
- Acute myocardial infarction
- Anemia
- Atrial fibrillation
- Hyperlipidemia
Respiratory Conditions:
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
Neurological and Mental Health Conditions:
- Alzheimer’s disease and related dementia
- Depression
- ADHD, conduct disorders, and hyperkinetic syndrome
- Personality disorders
- Post-traumatic stress disorder (PTSD)
- Anxiety disorders
- Depressive disorders
- Autism spectrum disorders
- Schizophrenia and other psychotic disorders
- Bipolar disorder
- Traumatic brain injury and nonpsychotic mental disorders due to brain damage
- Migraine and chronic headache
- Cerebral palsy
- Epilepsy
Cancer Conditions:
- Breast cancer
- Lung cancer
- Prostate cancer
- Colorectal cancer
- Endometrial cancer
Bone, Joint, or Muscle Conditions:
- Osteoporosis
- Rheumatoid arthritis/osteoarthritis
- Hip/pelvic fracture
- Spinal cord injury
- Spina bifida and other congenital anomalies of the nervous system
- Muscular dystrophy
- Pressure and chronic ulcers
- Fibromyalgia, chronic pain, and fatigue
Eye Conditions:
- Cataract
- Glaucoma
Additional CMS Chronic Conditions:
- Acquired hypothyroidism
- Chronic kidney disease
- Benign prostatic hyperplasia
- Diabetes
Substance Use Disorders:
- Alcohol use disorders
- Opioid use disorder
- Tobacco use
- Other drug use disorders
Autoimmune Conditions:
- Human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS)
- Viral hepatitis
- Multiple sclerosis and transverse myelitis
Blood Conditions:
- Sickle cell disease
- Leukemias and lymphomas
- Peripheral vascular disease (PVD)
Organ-Related Conditions:
- Liver disease, cirrhosis, and other liver conditions
- Cystic fibrosis and other metabolic developmental disorders
Other Disabling Conditions:
- Learning disabilities and other developmental delays
- Intellectual disabilities and related conditions
- Blindness and visual impairment
- Deafness and hearing impairment
- Mobility impairments
- Obesity
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