CCM Eligibility Calculator
Check whether a patient's condition profile commonly aligns with Medicare's Chronic Care Management eligibility criteria. This is an educational screening check, not a diagnosis or a billing determination.
What this checks:
Medicare's common CCM eligibility criteria, based on our Medicare CCM Eligibility guide. Final eligibility and billing decisions must always be made by the treating provider.
Do not enter protected health information (PHI). This tool asks only general yes/no questions — never a patient name, Medicare number, date of birth, or diagnosis detail.
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Where these criteria come from
These questions summarize Medicare's published Chronic Care Management eligibility criteria: two or more chronic conditions expected to last at least 12 months (or until death), significant risk of death/decompensation/functional decline, documented patient consent, and a comprehensive care plan. See our Medicare CCM Eligibility guide and the CCM Revenue Calculator to estimate program revenue.
Source: CMS Chronic Care Management Services MLN Booklet (MLN909188, June 2025). Source last checked September 30, 2026. This tool is for educational and planning purposes only and does not constitute legal, coding, billing, financial, or medical advice.
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