Chronic care management outreach: consent and cost

Chronic care management is a Medicare Part B service that a practice provides between visits to patients with two or more serious chronic conditions. The practice has to invite those patients, explain the service and get their consent before it can bill, so enrollment is a communication job as much as a clinical one. The invitation is also where things go wrong: a letter that calls the service free, a phone script that offers to skip the copay, an automated call that should not have been placed. This guide covers what CMS says the consent conversation must include, how to describe cost sharing, why a copay waiver cannot be part of an invitation, how calls and texts fit the federal telephone rules, and which claims about the program need care.

Several related topics have their own guides and are not repeated here. Gifts, free rides and the wider beneficiary inducement rule are covered in our guide to marketing to Medicare patients. The HIPAA test for when a patient message counts as marketing is set out in full in portal messages and HIPAA marketing, and the FCC health care exemption for texts is walked through condition by condition in text message appointment reminders. Paying anyone for patient referrals is covered in patient and physician referrals, recall lists in our patient recall system guide, and wider primary care marketing in the primary care practice marketing guide. Practices in an ACO should also check ACO marketing rules before sending program mailers.

This is general information, not legal or medical advice. Sources cited were checked on October 30, 2026: the CMS Medicare Learning Network booklet Chronic Care Management Services (MLN909188, June 2025), the Medicare.gov page on chronic care management services, 42 U.S.C. 1320a-7a (including (a)(5) and the definition of remuneration in (i)(6)), 42 U.S.C. 1320a-7b(b), 45 CFR 164.501, 47 CFR 64.1200, the FCC rule Enhancing the Ability of Consumers To Control the Robocalls (published October 26, 2026, effective November 25, 2026), 15 U.S.C. 45 and 52, and the FTC policy statements on deception and advertising substantiation. Billing codes, payment amounts and time thresholds change with each year’s Physician Fee Schedule and are not covered here. Scope of practice for clinical staff is set state by state.

What chronic care management is, in the words CMS uses

Start with the definition, because every outreach message has to match it. The CMS booklet describes chronic care management as managing a patient’s two or more chronic conditions that are expected to last at least 12 months, or until the patient’s death, and that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. CMS pays for it under the Physician Fee Schedule, and the booklet says it describes non-face-to-face services.

Who may bill: physicians, certified nurse-midwives, clinical nurse specialists, nurse practitioners and physician assistants. The booklet says the service is outside the scope of practice of clinical psychologists, podiatrists and dentists, who can still be consulted or referred to.
Clinical staff can provide the service under the billing practitioner’s direction and general supervision, subject to state law, licensure and scope of practice.
An initiating visit is required for new patients and for patients not seen in the previous year. It has to be a comprehensive evaluation and management visit, an annual wellness visit or an initial preventive physical exam, and chronic care management has to be discussed during it.
What the service includes: a comprehensive electronic care plan, 24/7 access to a practitioner or clinical staff for urgent needs, a designated care team member, medication review, and management of care transitions such as follow-up after a hospital discharge.

Medicare.gov describes the same service to patients: a care plan listing health problems, goals, other providers, medications and community services, 24/7 access for urgent needs, support when moving between care settings and a review of medicines. Using the patient-facing words from Medicare.gov in your invitations keeps your description close to what the patient will read if they look it up.

Finding the patients to invite

The CMS booklet suggests that billing practitioners may identify candidates using criteria in CPT guidance, such as the number of illnesses, the number of medications, or repeat hospital admissions or emergency department visits. In practice that means a list drawn from your own records by your own care team, reviewed by a clinician before anyone is contacted. A list built from a purchased data set or a web form for a vague health quiz is a different thing, and it brings both privacy and consent questions with it.

Under the HIPAA Privacy Rule, the definition of marketing in 45 CFR 164.501 leaves out communications for the treatment of an individual by a health care provider, including case management or care coordination, and communications describing a health-related service provided by the covered entity itself. An invitation from your practice to your own patient about your own care coordination service fits those exclusions. The exclusions fall away when the practice receives financial remuneration, meaning payment from a third party whose product or service is being described. If an outside company pays the practice in connection with the message, read the definition with your attorney before you send anything.

The consent conversation: what CMS says to cover

CMS requires the patient’s written or verbal consent before you bill. The booklet says the practice must inform the patient of the following and document it in the medical record:

That chronic care management is available.
Their possible cost-sharing responsibilities.
That only one practitioner can provide and bill the service in a calendar month.
Their right to stop at any time, effective at the end of the calendar month.
That you explained the required information, and whether the patient accepted or declined.

Consent is needed only once, unless the patient switches to a different practitioner for this service. Medicare.gov tells patients that their provider will ask them to sign an agreement to receive the service each month. Your outreach can introduce the service, but the consent itself belongs in a documented conversation where the patient can ask questions, not in a reply to a text or a click on a link. A short consent script that covers all five items in the same order every time makes the conversation easier for staff and easier to check later.

The one-practitioner rule matters for outreach. A patient who already gets this service from a specialist or another practice cannot have two practices bill for it in the same month. Ask early in the conversation whether anyone else already provides chronic care management, and record the answer.

Cost-sharing wording

Chronic care management is not free to the patient under Original Medicare. Medicare.gov says that after the Part B deductible, the patient pays 20% of the Medicare-approved amount, and that the specific amount depends on other insurance, what the doctor charges, whether the doctor accepts assignment and where the service is provided. The CMS booklet notes that supplemental insurance such as Medigap may help cover the cost sharing. Write the invitation so a patient who reads only one sentence about cost still gets it right.

Use: “Medicare Part B covers chronic care management. After your Part B deductible, you pay coinsurance, which is 20% of the Medicare-approved amount each month you receive the service. If you have supplemental coverage, it may pay some or all of that. We will tell you what to expect before you decide.”
Avoid: “free”, “no cost to you”, “fully covered by Medicare” or “Medicare pays for everything”.
Avoid: a monthly dollar figure for the patient’s share unless you have checked it against the current fee schedule and the patient’s coverage.
Medicare Advantage: costs depend on the plan, so tell the patient you will check their plan rather than quoting Original Medicare amounts.

Because the charge recurs each month, patients can be surprised months later by a line on a statement. Saying in the invitation, in the consent conversation and in the welcome letter that the charge is monthly heads off that surprise.

Waiving the copay is not an enrollment offer

It can be tempting to make enrollment easier by offering to skip the coinsurance. Federal law treats that as remuneration. Under 42 U.S.C. 1320a-7a(a)(5), a person who offers or transfers remuneration to a Medicare or state health care program beneficiary that the person knows or should know is likely to influence the beneficiary to receive covered services from a particular provider is subject to civil monetary penalties. The definition of remuneration in 1320a-7a(i)(6) includes the waiver of coinsurance and deductible amounts.

The same definition has a narrow exception. A waiver is not remuneration only if all of these are true: it is not offered as part of any advertisement or solicitation, the person does not routinely waive coinsurance or deductibles, and the waiver follows a good faith determination that the patient is in financial need, or follows a failure to collect after reasonable collection efforts. An invitation that says “no copay” is a solicitation by definition, so the exception cannot apply to it. If a patient tells you they cannot afford the coinsurance, handle it through your written financial hardship process, case by case, and keep it out of the outreach.

The Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), also makes it a felony to knowingly and willfully offer or pay remuneration to induce someone to refer, order or arrange for or recommend services paid by a federal health care program. Our referrals guide covers the statute and its safe harbors.

Outside companies and enrollment counts

A practice may bring in an outside company to run enrollment calls and monthly check-ins. The CMS booklet describes clinical staff as employees or people working under contract with the billing practitioner, providing the service under the practitioner’s direction. That leaves several questions for the practice to settle in writing before any outreach starts.

Who the caller says they are. A patient should hear the name of your practice and the fact that the caller works with it, and should not be led to believe they are speaking with Medicare.
How the company is paid. Pay that rises with the number of patients a company enrolls or recommends is the kind of arrangement 1320a-7b(b) is written about. Ask a health care attorney to review it.
What patient information the company receives and under which agreement. A company handling patient information for the practice is a business associate, and the agreement has to be in place first.
Who keeps the consent record and the care plan, and how the practice can check them.

Calls, texts and the federal telephone rules

The Telephone Consumer Protection Act rules at 47 CFR 64.1200 set the limits for automated calls and texts. Under 64.1200(a)(1)(iii), a call to a cell phone using an automatic telephone dialing system or an artificial or prerecorded voice needs the called party’s prior express consent unless it is made for emergency purposes. Under 64.1200(a)(2), an automated call that includes an advertisement or constitutes telemarketing needs prior express written consent, except for a call that delivers a health care message made by or on behalf of a HIPAA covered entity or its business associate.

For prerecorded calls to a residential line, 64.1200(a)(3)(v) allows health care messages from a covered entity or business associate without consent only if the caller makes no more than one call per day to each patient, up to three calls a week, and honors opt-out requests. Whether a particular enrollment invitation is a health care message or an advertisement depends on what it says, so settle that with counsel before you automate it, and use a live staff call where you are unsure.

The FCC published a rule on October 26, 2026, effective November 25, 2026, on revoking consent to robocalls. According to its summary, callers may treat a revocation request as applying only to the specific category of informational calls it was directed at, and may designate an exclusive means for revoking consent. If your practice sends several kinds of automated messages, such as reminders and care management check-ins, review how stop requests are sorted before that date. The full condition-by-condition walk-through of the health care exemption is in our appointment reminder texting guide.

Practices that also run a long COVID or post-viral clinic can use our long COVID clinic marketing guide for claims, rehabilitation wording and intake for those patients.

Claims about the program

An invitation that describes chronic care management makes claims about access and about results, and both are covered by the FTC Act. Section 5 (15 U.S.C. 45) prohibits deceptive acts and practices, and section 12 (15 U.S.C. 52) prohibits false advertisements for services. Under the FTC’s policy statement on substantiation, you need a reasonable basis for objective claims before you make them.

24/7 access: the CMS booklet lists 24/7 access to a practitioner or clinical staff for urgent needs as part of the service. Say what that means in your practice, for example a number answered by a clinician or clinical staff at all hours, and do not describe it as an in-person visit at any hour.
A dedicated contact: the booklet lists a designated care team member who is regularly in touch with the patient. If you promise a named nurse or coordinator, make sure staffing supports it.
Results: claims such as “fewer hospital stays”, “better blood sugar control” or “lower costs” are outcome claims. The CMS booklet says the service may help avoid the need for more costly services in the future, which is a statement about the program, not a promise to any patient. Do not turn it into one.
Medicare’s name: say that Medicare Part B covers the service, and avoid wording that suggests the letter comes from Medicare or that the patient has been selected by Medicare.

Stopping, switching and the follow-up message

CMS gives the patient the right to stop at any time, effective at the end of the calendar month. Put that right in the invitation, the consent script and the welcome letter, and make stopping easy: a phone number and a named role, not a form the patient has to find. Record the date the patient asked to stop so that billing ends with that month. If a patient switches to another practitioner for this service, new consent is required there, and your records should show when your service ended.

Illustration: one letter and one phone call

Illustration: a family practice reviews its own records and its physicians mark patients with two or more qualifying chronic conditions who were seen in the past year. The practice mails a one-page letter on its own letterhead, signed by the patient’s physician. It explains in Medicare.gov’s words what the service includes, says that Part B covers it and that the patient pays coinsurance after the deductible each month, mentions that supplemental coverage may pay some or all of that, and says the patient can stop at any time. It gives a phone number and the name of the nurse who will call. It says nothing about waiving the copay and makes no promise about hospital visits.

Illustration: a week later the nurse calls in person, not with a recorded message. The nurse asks whether another practice already provides this service, walks through the five consent items from the CMS booklet in order, answers the patient’s question about cost by offering to check their supplemental coverage, and records in the chart that the information was explained and whether the patient accepted. A patient who says they cannot afford the coinsurance is referred to the practice’s written financial hardship policy, which is applied the same way to every patient who asks.

Checklist

The invitation list comes from your own records and was reviewed by a clinician.
Every candidate has had, or will have, a qualifying initiating visit where the service is discussed.
The invitation describes the service in words that match the CMS booklet and Medicare.gov.
Cost wording says the patient pays coinsurance after the Part B deductible, each month, and never says free or fully covered.
No copay waiver, gift or discount appears in any outreach.
The consent script covers all five CMS items and the chart records the result.
Staff ask whether another practitioner already provides the service.
Automated calls and texts have been checked against 47 CFR 64.1200, with stop requests handled under the rule effective November 25, 2026.
Any outside company is identified as working with the practice, has a business associate agreement in place, and its pay terms have been reviewed by counsel.
Access and outcome claims each have a record behind them.
Stopping is easy and ends billing at the end of that month.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices and health businesses. For a practice starting chronic care management, that means a website page that explains the service and its cost in the same words as your letters, invitation letters and phone scripts that follow the CMS consent items, and inquiry flows that route questions about cost and enrollment to the right person on your team. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. We do not sell lead lists and we do not pay for referrals. For the wider rules, see our healthcare marketing rules hub.

Is chronic care management free for Medicare patients?

Not under Original Medicare. Medicare.gov says that after the Part B deductible, the patient pays 20% of the Medicare-approved amount. Supplemental coverage may pay some or all of that, and the amount depends on the patient’s other coverage and the practice.

Does the patient have to sign something?

CMS requires written or verbal consent before billing, documented in the medical record, and Medicare.gov tells patients their provider will ask them to sign an agreement. Consent is needed once unless the patient switches practitioners.

Can we waive the coinsurance to encourage patients to enroll?

Not as part of outreach. Under 42 U.S.C. 1320a-7a(i)(6), a waiver falls outside the definition of remuneration only if it is not advertised or offered in a solicitation, is not routine, and follows a good faith finding of financial need or failed collection efforts.

Is a letter inviting our own patients to chronic care management HIPAA marketing?

The definition in 45 CFR 164.501 excludes communications for treatment, case management and care coordination, and descriptions of the provider’s own health-related services, unless the practice receives payment from a third party whose product or service is described.

Can we use automated calls or texts to invite patients?

Automated calls and texts are governed by 47 CFR 64.1200. Calls to cell phones need prior express consent, and advertising calls need prior express written consent unless they deliver a health care message from a covered entity or its business associate. Ask counsel which category your message falls in.

How does a patient stop the service?

CMS says the patient can stop at any time, effective at the end of the calendar month. Tell patients how to stop in the invitation and the consent conversation, and record the date they ask.

Sources

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Chronic care management outreach: consent, cost sharing and enrollment messages that stay inside the rules