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Official Description

Chronic care management services 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 that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
  • comprehensive care plan established, implemented, revised, or monitored;
first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

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