Chronic Care Management (CCM) Monthly Note

Note Type: Chronic Care Management (CCM) Monthly Note

Service Period: [Month/Year] ([start date] – [end date])

Patient: [Name], DOB [date], MRN [number]

Billing Practitioner: [Name, credentials]

Care Team Contributors: [Names and roles of staff who performed CCM activities this month] (Omit if none.)

Date Finalized: [date note signed]

(Omit lines without content rather than displaying placeholders. If key identifiers are missing, document the gap and hold billing as indicated.)

Eligibility & Consent

Qualifying Conditions: [List the ≥2 chronic conditions meeting CCM criteria]

Consent Status: [On file: Yes/No] | [Verbal/Written] | [Date obtained]

(If consent was newly obtained this month, document that required disclosures were reviewed: availability of services, cost-sharing, single-practitioner billing rule, and right to discontinue. If consent is on file from a prior month, state: "Consent verified on file, no revocation this month.")

Interval Status & CCM Activities

[Brief interval status since last month: patient-reported symptoms, new events, medication adherence or changes, and relevant functional/psychosocial updates] (If no new clinical information is available, state this explicitly.)

CCM Activities This Month:

• [Activity performed → outcome or next step]
• [Additional activities as applicable]

(Include only activities that occurred. Common types include medication management, referral coordination, transitions of care support, patient education, SDOH navigation, and care plan review. Do not list categories without activity.)

Time Log & Summary

Date	Staff (name, role)	Mode	Activity Description	Minutes
[date]	[name, role]	[phone / portal / chart review / external contact]	[concise activity description]	[minutes]

(Add rows as needed for this calendar month.)

Total CCM Minutes This Month: [number]

Billing Threshold Met: [Yes / No] (If yes, note code pathway. If no, state: "Threshold not met—CCM not billed for this period.")

Compliance Statement: CCM time documented here is not counted toward any other billed service for this patient during this calendar month.

Care Plan Update

Care Plan Reviewed/Updated: [date]

Copy Provided to Patient/Caregiver: [Yes / No], [method], [date] (Omit if not applicable this month.)

Active Problems Addressed:

• [Condition]: [Current status. Goals. Current interventions. Monitoring plan. Barriers if relevant. Next steps with target dates.]
• [Additional conditions as applicable]

(Repeat problem-oriented format for each active condition addressed this month. If patient goals were not elicited, document: "Patient goals: not elicited this month—planned outreach next month.")

Next Month Tasks:

• [Task] — [Owner] — [Target date]

Authentication

Signed by: [Name, credentials] | Date/Time: [timestamp]

Billing Practitioner Attestation: I have reviewed the CCM activities and time summary, supervised clinical staff as applicable, and confirm the care plan was reviewed/updated and is medically necessary.

(Use direct patient quotes only when they clarify goals, preferences, or refusals. Do not fabricate identifiers or consent; document gaps explicitly.)