Chronic Disease Management (CDM) Tariffs
The five chronic disease management (CDM) tariffs were introduced to help doctors spend more time with the patients who need it most. These tariffs also acknowledge the link between comprehensive chronic disease management and better patient health.
These tariffs are billable annually for providing comprehensive chronic disease management to a patient with one or more of the following chronic diseases:
- Congestive Heart Failure
- Coronary Artery Disease
Who can bill these tariffs?
These tariffs may be billed by a General Practice physician who has provided:
- the majority of a patient’s ongoing comprehensive medical care in relation to the management of the chronic disease in the preceding 12 months;
- ongoing coordination with other allied health care providers respecting the management of the patient’s condition and patient care plan, as appropriate;
- ongoing communication with the patient, monitoring of the patient’s condition and patient care plan, as appropriate; and
- supporting information to Manitoba Health demonstrating that the patient has received all the required services for the tariff during the preceding 12 months.
This supporting information may be submitted on an approved Patient Care Treatment Form, or by data extract from a Manitoba-approved Electronic Medical Record (EMR) system containing equivalent information.
More information about eligibility to claim tariffs is available in the FAQs at the bottom of this page.
Chronic Disease Management – Manitoba Primary Care Quality Indicators Guide
This document has been created to identify the indicators required to assess the medical claim tariff billed against the chronic disease management patient care treatment forms. The purpose of this document is to describe the indicators that Manitoba Health has adopted for measuring quality processes in primary care, and which are currently used in conjunction with the chronic disease tariff billed through the Claims Unit in Fee-For-Service/Insured Services.
Patient Care Treatment Forms
The following Patient Care Treatment Forms were developed with physician input and reviewed by Doctors Manitoba.
Fill and Print Forms:
A Patient Care Treatment form is not required in order to bill for Annual Management of Asthma. The physician must complete an Asthma Action Plan and retain the information in the patient’s record. Remarks on the claim advising that an Asthma Action Plan was completed are sufficient for billing purposes.
Patient Care Treatment Forms may be submitted to Manitoba Health by mail.
3066-300 Carlton St.
Winnipeg MB R3B 3M9
300 Carlton Street
Frequently Asked Questions
In order to bill a CDM tariff a physician must meet all eligibility requirements stipulated in the tariff. Specifically, a physician must:
- be a General Practice physician;
- provide the majority of the patient’s ongoing comprehensive medical care in relation to the active management of the specific chronic disease(s) diagnosed;
- 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
- ensure that all of the required services for that particular tariff have been provided to the patient within the preceding 12 months.
Effective April 1, 2012, you may bill for the care that you are currently providing to patients with a diagnosis of Diabetes, Congestive Heart Failure, Coronary Artery Disease and/or Asthma, provided that all other requirements are met.
Effective April 1, 2013, you may bill for the care that you are providing to patients with a diagnosis of Hypertension, provided that all other requirements are met.
Each tariff may only be claimed once, per patient, in any 12-month period. Only one physician may claim each tariff for a single patient in a 12-month period.
Where a patient is treated for the management of more than one of the listed diseases, a tariff may be billed for each disease. Claims for additional services (e.g. visits) are payable in addition to these tariffs.
Yes. A separate claim needs to be submitted for each CDM tariff claimed. For example, two (2) 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.
Claims for the CDM tariffs should be submitted 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.
Claims for Tariff 8432 – Asthma – require a remark on the claim stating “Asthma Action Plan completed”
Claims for all other CDM tariffs must be accompanied by supporting information. Supporting information must be documented on an approved Patient Care Treatment Form.
Physicians using a Manitoba-approved Electronic Medical Record (EMR) system will have the option of submitting supporting information through a data extract from their EMR in future. Manitoba Health is in the process of implementing systems that will enable this option. More information will be provided as it becomes available.
It is recommended that you submit the Patient Care Treatment Forms on or around the same date that you submit your medical claim(s) for that patient.
If you are using a Manitoba-approved EMR and interested in using this option when it becomes available you may need to change your EMR configuration and use in order to capture the supporting information in your EMR in the appropriate format. Your Manitoba-approved EMR vendor can assist you. Please contact your Vendor or your EMR Adoption Program CSR for more information.
If you are participating in PIN, your PIN data extracts will contain the necessary supporting information, as long as all the required services have been completed for the patient in the preceding 12 months, and data about these services has been entered and extracted appropriately. Provided this is the case, you do not need to submit Patient Care Treatment Forms. You do still need to submit the associated medical claim(s).