CMS Pub. 100-02, ch. 13, § 230.2.1

A separately billable initiating visit with an RHC or FQHC primary care practitioner

(physician, NP, PA, or CNM) is required before care management services can be

furnished. This visit can be an E/M, AWV, or IPPE visit, and must occur no more than

one-year prior to commencing care management services. Care management services do

not need to have been discussed during the initiating visit. Beneficiary consent to receive

care management services can be obtained by auxiliary staff under general supervision of

the RHC or FQHC primary care practitioner as well as by the billing practitioner, may be

written or verbal and must be documented in the patient’s medical record before CCM

services are furnished. The medical record should document that the beneficiary has

been informed about the availability of care management services, has given permission

to consult with relevant specialists as needed, and has been informed of all of the

following:

• There may be cost-sharing (e.g. deductible and coinsurance in RHCs, and

coinsurance in FQHCs) for both in-person and non-face-to-face services that are

provided;

• Only one practitioner/facility can furnish and be paid for these services during a

calendar month; and

• They can stop care management services at any time, effective at the end of the

calendar month.