Chronic Disease Management Tariffs (CDM)
Physicians may utilize Chronic Disease Management Tariffs (CDM) or Comprehensive Management Tariffs (CCM) to care for patients with chronic diseases. Also see CCM Tariffs.
Chronic Disease Management tariffs remunerate general practice physicians who provide most of a patient’s ongoing comprehensive care concerning the active management of specific chronic disease(s) during the preceding 12 months. Specifically, these tariffs and chronic diseases are as follows:
Annual Management of Diabetes
Annual Management of Asthma
Annual Management of Congestive Heart Failure
Annual Management of Coronary Artery Disease
Annual Management of Hypertension
This article will provide you with answers to two critical questions:
- When am I eligible to bill these tariffs?
- How do I bill these tariffs?
When am I eligible to claim a CDM Tariff?
To bill a CDM tariff, a physician must meet all eligibility requirements stipulated in the tariff. More specifically, a physician must:
- be a general practitioner physician;
- provide the majority of the patient’s ongoing comprehensive care concerning the active management of the specific chronic disease(s) diagnosed, this means that only one physician may bill for this patient in each 12 month period.
- have provided ongoing comprehensive care during the preceding 12 months, billing for care and management provided in the previous 12 month period, with each tariff claimed once in any 12 month period.
- provide ongoing coordination with other allied health care providers respecting the management of the patient’s condition and patient care plan as appropriate;
- provide ongoing communication with the patient, monitoring of the patient’s condition and patient care plan as appropriate; and
- provide all of the required services for the particular tariff as listed below, such services must be recorded in the patient’s chart and, where indicated, on the Patient Care Treatment Form that is to be submitted to Manitoba Health.
Note: Having met all other requirements, you may bill for the care that you are currently providing this patient. Physicians must have seen the patient at least once in the previous 12 months to claim.
Asthma: For asthma patients, physicians must develop and review an Asthma Action Plan. The Asthma Action Plan is available from the Canadian Asthma Society.
For billing purposes, it is sufficient to note the completion of the Asthma Action Plan on claim. Retain a copy of the action plan in your files for audit purposes.
|Congestive Heart Failure||Coronary Artery Disease||Diabetes|
|Blood pressure measurement||Blood pressure measurement||Blood pressure measurement|
|Obesity/overweight screening||Obesity/overweight screening||Obesity/overweight screening|
|Full fasting lipid profile screening (only for patients from 18 to 74 years of age)||Full fasting lipid profile screening (only for patients from 18 to 74 years of age)||Full fasting lipid profile screening (only for patients from 18 to 74 years of age)|
|Fasting blood sugar test (not required for patients with diabetes)||Fasting blood sugar test (not required for patients with diabetes)||Fasting blood sugar test (not required for patients with diabetes)|
|Management of ACE inhibitor or ARB use||Management of beta-blocking medication (patients aged 18 to 74) who have had an acute myocardial infarction, do not have asthma and have been prescribed a beta-blocking medication||Fundoscopic examination or referral for a fundoscopic examination|
|Lipid reduction counselling (patients aged 18 to 74) with LD levels of greater than 2.0 mmol/L or prescribed with lipid-lowering medication||HGB A1C test, Nephropathology screening|
How to Bill for CDM Tariffs
Below are details to assist you with billing these tariffs.
Q: Am I required to submit a separate claim for each Chronic Disease Management (CDM) tariff associated with a single patient?
A: Yes. Submit a separate claim for each CDM tariff claimed.
For example, two separate claims must be submitted when billing CDM tariffs for both Diabetes (8431) and Coronary Artery Disease (8434) for a single patient. The ICD code for each claim must match the disease.
Q: How do claim submissions for the CDM tariffs (8431, 8432, 8433, and 8434) differ from my other claim submissions?
A: Submit claims for the CDM tariffs through your normal claims submission process. The difference is that these tariffs also require supporting information with respect to the management of the patient’s disease.
Q: What additional information do I need to submit when claiming Tariff 8432 for Asthma?
A: Claims for Tariff 8432 – Asthma require a remark on the claim stating “Asthma Action Plan completed”
Q: What additional information do I need to submit when claiming all other CDM Tariffs?
A: A completed Patient Care Treatment Form must accompany claims for all other CDM tariffs.
Q: What is a Patient Care Treatment Form, and where can I get them?
A: Patient Care Treatment Forms are forms designed by Manitoba Health to assist Physicians in providing the information required to bill these tariffs. When completed, they will provide Manitoba Health with the evidence necessary to demonstrate the physician provided all required services. Download the forms from:
- Electronic Practitioners integrated Claims Submissions (EPiCS) System on the Secure Internet Solutions application Portal.
- Government of Manitoba
Q: How do I submit the Patient Care Treatment form?
A: Forms must be submitted to Manitoba Health as follows:
Mail or drop off:
300 Carlton Street
Winnipeg MB R3B 3M9
Q: When should I submit the Patient Care Treatment Forms?
A: Submit the Patient Care Treatment Forms on or around the same date you submit your CDM claim(s) for the patient.
Q: Can I use my EMR to submit the information on the Patient Care Treatment Forms?
A: Yes, Manitoba Health has implemented systems that enable physicians with certain EMRs to provide data extracts that pull information directly from the patient record and alleviate the need to re-enter information on Patient Care Treatment Forms manually. If you provide Manitoba Health with monthly data extracts, you do not need to submit forms.
For further information, contact your software vendor or e‑Health.
See article on Comprehensive Care Management tariffs.