Chronic care management consent requirements

A chronic care management consent form can support the discussion, but a signature alone does not show what the patient was told. CMS requires the medical record to document the required information and the patient’s decision.

Use the sample wording below as a starting point for your practice’s process, including a verbal-consent note when that approach fits. The wording addresses the CMS disclosures; it should be reviewed alongside your practice’s own patient communication and recordkeeping procedures.

What a chronic care management consent form must cover

Before billing, CMS requires written or verbal consent and documentation in the medical record. The required information includes the availability of CCM, possible cost sharing, the fact that only one practitioner can furnish and bill CCM in a calendar month, and the right to stop at any time effective at the end of that month.

Disclosure	Sample patient-facing wording	Record to retain
Availability	Chronic care management services are available through this practice.	The service was explained and offered.
Possible cost sharing	You may have cost-sharing responsibilities for these services.	Possible cost sharing was discussed; unresolved coverage questions identified.
One practitioner	Only one practitioner can provide and bill chronic care management services for you in a calendar month.	The responsible CCM practitioner is identified.
Right to stop	You may stop chronic care management at any time. Stopping takes effect at the end of the calendar month.	The stopping rule was explained.
Patient decision	Do you accept or decline chronic care management services?	Acceptance or refusal and the explanation are documented in the medical record.

This sample does not promise a particular patient charge or describe the service as automatically covered. Your billing team should answer coverage questions from the patient’s actual information. If a question remains unresolved, record it and arrange an answer before treating the discussion as complete.

Keep the responsible practitioner clear when using a practice name on the form. The one-practitioner rule concerns CCM during a calendar month, so patients need to understand which team is coordinating the service. A general permission to contact the patient does not communicate that billing arrangement.

How to complete the chronic care management consent form

Step 1: Check eligibility and the initiating-visit decision

CCM is for patients with multiple chronic conditions meeting the CMS duration and significant-risk criteria. For a new patient or one the billing practitioner has not seen within the previous year, a qualifying initiating visit is required. The practitioner must discuss CCM for that encounter to count.

Do not use the consent form to stand in for the visit record. CMS treats the initiating visit and informed consent as separate requirements, and consent need not be obtained during the visit. The CCM requirements checklist explains the prerequisites beyond this discussion.

Step 2: Explain the disclosures and invite questions

Walk through the required information before asking for the patient’s choice. Ask whether another practitioner already provides CCM and whether the patient has questions about possible cost sharing. These are practical discussion prompts that help the practice apply the disclosures rather than race through a signature field.

Keep the explanation close to the form language so the record and conversation agree. If staff use a separate script, review it whenever the form changes. A clear script should help staff cover the required points without making extra promises about coverage or services.

Step 3: Record acceptance or refusal

CMS requires the record to show that the information was explained and whether the patient accepted or declined. A practical record also identifies the patient, practitioner, discussion date and person documenting it. Those identifying fields help the practice locate and interpret the consent record.

For written consent, keep the completed form accessible from the medical record used for claim review. For verbal consent, write a note describing the explanation and the patient’s decision. Do not leave the only evidence in an outreach spreadsheet that the billing team cannot connect to the chart.

A verbal-consent script and chart-note example

CMS allows verbal consent, so an absent handwritten signature is not automatically a missing-consent problem. The practice still must document the required explanation and decision. Use a note that tells the reviewer what happened instead of a bare status label.

A discussion can follow this wording: “Chronic care management is available through this practice. You may have cost-sharing responsibilities, and only one practitioner can provide and bill CCM for you in a calendar month. You may stop at any time, effective at the end of that calendar month.”

Then ask: “What questions do you have, and do you accept or decline these services?” Allow the patient to answer rather than treating silence as acceptance. Record the answer and any question that needs follow-up.

A sample note could read: “On [date], [staff member] explained CCM availability, possible cost sharing, the one-practitioner-per-calendar-month rule and the right to stop effective at month end to [patient]. The patient [accepted/declined] CCM through [billing practitioner]. Questions and follow-up: [record what was asked and answered].”

The bracketed fields are prompts for actual information, not text to leave in a completed record. If the patient has not decided, state that clearly and keep the consent status unresolved. Do not substitute the sample’s acceptance option for the patient’s own answer.

Avoid adding blanket authorization language to this CMS disclosure sample without a separate practice review. Consent for CCM, general treatment permission and any other authorization serve different operational purposes. This guide establishes the CCM information requirement rather than deciding all other forms your organization may use.

Review the consent record before the billing handoff

Step 4: Check the disclosure record and practitioner

Make sure the record is readable, belongs to the correct patient and names the responsible CCM practitioner. Verify that all required disclosures were explained and the patient’s decision is explicit. A form marked complete in software may still need review if the underlying document is blank or ambiguous.

If another practitioner is already providing CCM, resolve responsibility before proceeding. The patient should not have to discover competing enrollment records from a claim notice. Use the one-practitioner discussion to identify the coordination question early.

Step 5: Keep the monthly service review separate

Consent permits the practice to proceed under the applicable rules; it does not establish that a particular monthly service was furnished. The care plan, scope and selected code requirements still apply. Do not build a recurring claim simply from the date a consent form was signed.

The CCM enrollment workflow places this discussion within the broader process. Keep a consent-ready status separate from the final ready-to-bill status so the team can see which decision has actually been completed.

Step	Who does it	What CMS requires	Record kept
Explain	Practice consent workflow	Availability, cost sharing, one practitioner and right to stop	Completed disclosure record
Decide	Patient, with practice documentation	Acceptance or refusal documented	Written form or verbal-consent note
Verify	Practice enrollment and billing team	Required consent before billing	Accessible medical-record entry
Update	Responsible practice team	New consent when changing CCM practitioners; stopping effective at month end	Practitioner change or stop request and follow-up status

The table assigns practical ownership rather than prescribing a new CMS staff category. Your practice should decide who may conduct and document the discussion under its policies. Ensure that the billing practitioner can review questions that affect the proposed service.

Repeat consent, practitioner changes and stopping services

Step 6: Maintain an accurate consent status

CMS says patients generally provide informed consent once unless they switch to a different CCM practitioner. Do not describe a monthly or annual re-signature as a universal CMS requirement. A practice may review patient preferences operationally without claiming that Medicare requires a recurring new form.

When the patient changes CCM practitioners, obtain the required new consent for the new arrangement. Resolve the calendar-month responsibility rather than assuming the change permits both practitioners to bill. Record the change so staff do not rely on the previous practitioner’s consent entry.

Patients may stop at any time, with stopping effective at the end of the calendar month. A practical process records the request, the date received and the staff member responsible for updating enrollment and billing status. This keeps the patient’s instruction connected to the teams that need to act on it.

Do not promise that requesting a stop erases a previously furnished service or settles every claim question. The billing team should review the relevant month and actual services separately. Explain the effective timing plainly and direct unresolved account questions to the responsible practice staff.

Keep a visible distinction among accepted, declined, undecided and stopped. These are practical workflow statuses, not additional Medicare consent categories. Their value is that a staff member can tell whether the patient has made a decision and what action remains.

Consent mistakes that should hold a claim

If the chart does not establish consent, address the missing requirement rather than rewriting an old entry to imply an earlier conversation occurred. Record what actually happened and when. Escalate the affected service period to the billing practitioner and billing lead for review.

Connect consent to your practice service model

Practices planning chronic care management should define where the consent record lives and how unresolved questions reach the practitioner. Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Which team members’ time counts toward each code is set in your services agreement. Keep the consent decision, the care plan and the monthly billing review connected in the handoff.

Key takeaways

• CMS permits written or verbal CCM consent.
• Document all required disclosures and acceptance or refusal.
• Consent and the initiating visit are separate requirements.
• New consent is required when the patient changes CCM practitioners.
• Consent alone does not establish a monthly claim.

Frequently asked questions about chronic care management consent form

Does a CCM patient have to sign a paper form?

CMS allows written or verbal consent. The required information and the patient’s decision must be documented in the medical record.

What must a verbal-consent note include?

It should show that the required disclosures were explained and whether the patient accepted or declined. Identifying the date and responsible practitioner helps the practice interpret the record.

Does CMS require annual renewal of CCM consent?

CMS generally requires informed consent once. A change to a different CCM practitioner requires new consent.

Can a consent signature replace the initiating visit?

No. They are separate requirements, and a qualifying visit is still needed when the CMS initiating-visit rule applies.

When does a patient’s request to stop CCM take effect?

The patient may stop at any time. CMS specifies that stopping takes effect at the end of the calendar month.

Can the practice bill the patient if Medicare cannot be billed because consent is absent?

No. The CMS FAQ says neither Medicare nor the patient can be billed without the required consent.

For physician practices evaluating Companian, Medicare Part B chronic care management codes 99490 and 99439 require documented informed consent alongside the other service requirements. Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Read more: CCM enrollment workflow · CCM requirements

Disclosures

This guide summarizes CMS rules for practices nationwide and is not legal or billing advice. Sources:

• CMS MLN909188, Chronic Care Management Services
• CMS, Advanced Primary Care Management services
• CMS, Health-Related Social Needs FAQ