Chronic Care Management (CCM) CPT Codes & Requirements

By Prateek Haswani | January 22, 2024

Chronic Care Management (CCM) services are non-face-to-face services offered to Medicare beneficiaries with two or more chronic diseases that are expected to last at least 12 months or until the patient’s death.

The Centers for Medicare and Medicaid Services (CMS) recognize that CCM services are essential components of primary care that promote better health and lower total healthcare expenditures. CCM allows physicians and healthcare organizations to provide ongoing therapy to patients via remote interactions.

Medicare will reimburse for the CCM program if at least 20 minutes of patient service is provided every month. To be eligible for CCM, a patient must have two or more chronic diseases and the physician must report any chronic ailments one is experiencing 12 months before the CCM participation.

Table of Contents

What Does Chronic Care Management (CCM) Service Include?

CCM service includes:

Monthly clinical review
Telephone calls
Physician reviews
Doctor referrals
Prescription refills
Chart reviews
Scheduling appointments

Individual care plans are formulated in collaboration with the patients to determine the service offerings after they are enrolled in the CCM. These care plans address everything, right from the patient’s medical history to goals, symptoms, medications, risk classification, and response behavior.

CPT Codes For CCM Services

The four CPT codes used to report CCM services in 2024 are:

1. CPT Code 99490

This non-complex CCM is a 20-minute timed service per month, provided by clinical staff to coordinate treatment among providers and enhance patient responsibility with a $64 reimbursement rate. The requirements to be met include:

Multiple (two or more) chronic diseases are predicted to continue for at least 12 months or until the patient’s death.
Chronic conditions that put a patient at high risk of death, acute exacerbation, or functional decline.
A comprehensive care plan needs to be developed and implemented. As the monitoring continues, this care plan should be amended based on ongoing treatment.

2. CPT Code 99439

This is an add-on code to 99490 and billed in conjunction with it. Chronic care management services code 99439, each additional 20 minutes over the initial 20 minutes of clinical staff time directed by a physician or other qualified health care professional, with a reimbursement rate of $48 per calendar month.

3. CPT Code 99491

CCM services provided personally by a physician or other qualified health care professional for at least 30 minutes, per calendar month are reimbursed for $86, with the following requirements:

Multiple (two or more) chronic diseases are predicted to continue for at least 12 months or until the patient’s death.
Chronic conditions that put a patient at high risk of death, acute exacerbation, or functional decline.
A comprehensive care plan needs to be developed and implemented. As the monitoring continues, this care plan should be amended based on ongoing treatment.

4. CPT Code 99437

This add-on code to 99491 is reimbursed for $61. Chronic care management services each additional 30 minutes by a qualified health care professional, clinician, or physician, per calendar month.

Documentation & Requirements For CCM

CCM services cover several patient and physician services that must be documented in the electronic health record (EHR). Some of the covered services include, but are not limited to:

Management of chronic conditions
Management of prescriptions
Management of referrals
Ongoing review of patient status

The requirements for non-complex CCM include:

Two or more chronic conditions expected to last at least 12 months or until the patient’s death
Patient consent in a verbal or signed form
Personalized care plan and the EHR copy provided to the patient
24/7 patient access to the care team member for urgent needs
Non-face-to-face communication between patient and physicians
Management of care transitions and settings
At least 20 minutes of clinical staff time per calendar month spent on non-face-to-face CCM services directed by a physician or other qualified healthcare professional
CCM services are reported using CPT code 99491 and require at least 30 minutes of personal time spent on care management services

Streamline CCM With HealthArc’s Monitoring Services

To deliver accurate and efficient CCM services, we have a suite of FDA-approved remote monitoring devices, patient communication and interaction capabilities, a dedicated customer success team, clinical software, a physician dashboard, and billing capabilities in place that provide a comprehensive monitoring solution. This helps boost the efficiency of you and your staff, which ultimately leads to better patient engagement and management.

We are your reliable partner in enhancing chronic care and management of patient outcomes. Our Chronic Care Management (CCM) software is designed to scale your healthcare results and make patient monitoring and management easy.

Please request a free demo to learn about how we can help your organization achieve its care management goals. Also, feel free to talk to our team at +201 885 5571 for any queries about the CCM codes.

Frequently Asked Questions (FAQs)

What is Chronic Care Management (CCM)?

Chronic Care Management (CCM) is a type of Medicare-covered service for people with two or more chronic diseases that are projected to last at least 12 months. It is meant to coordinate care, improve outcomes, and lower total healthcare expenditures.

Who qualifies for CCM services under Medicare?

To qualify, a patient must have two or more chronic conditions expected to last at least 12 months or until death, and those conditions must significantly increase the risk of death, functional decline, or acute exacerbation.

What CPT codes are used for billing CCM services?

Common CCM CPT codes include:

99490: 20 minutes of non-complex care per month
99439: Add-on for each additional 20 minutes
99491: 30 minutes of CCM personally by a physician/NPP
99437: Add-on 30 minutes for physician/NPP-provided care
99487 & 99489: Codes for complex CCM services

How is CCM different from other care management programs?

CCM focuses on ongoing, coordinated, non-face-to-face care for chronic conditions. Unlike primary care visits, CCM reimburses for care coordination activities such as medication management, chart review, and patient communication.

Can CCM be delivered by clinical staff under supervision?

Yes. CCM services can be furnished by clinical staff under the general supervision of a physician or qualified healthcare provider — documentation of time spent is required for billing.

Do patients need to consent to CCM participation?

Yes. Medicare requires documented patient consent (verbal or written) before billing CCM services.

What must be included in a comprehensive CCM care plan?

A CCM care plan should cover patient history, goals, medications, risk classification, symptoms, care coordination strategies, and updates over time. A copy must be provided to the patient.

How often can CCM services be billed?

As long as the documentation meets the minimum duration and service requirements set by the code utilized, providers can bill CCM codes once a month.

Are CCM services billable if the patient isn’t reached directly?

Yes. Billable time can include non-face-to-face activities like chart review, communication with other clinicians, and care coordination — even if the patient isn’t directly contacted in a given month.

Can CCM be billed in the same month as Transitional Care Management (TCM)?

Yes. Billable time can include things that don’t involve seeing the patient in person, like reviewing charts, talking to other doctors, and coordinating care, even if the patient isn’t directly contacted that month.

Who is eligible to bill CCM services?

Physicians and select qualified practitioners — including nurse practitioners, physician assistants, certified nurse midwives, and clinical nurse specialists — may bill CCM.

What chronic conditions typically count for CCM eligibility?

Some examples are diabetes, high blood pressure, COPD, heart disease, cancer, asthma, mental health problems, and many other long-term ailments.

Is patient co-pay required for CCM services?

Medicare may require patients to pay coinsurance for CCM services. Prices are different, and certain extra plans may pay for the cost. Always check with Medicare or your payer’s rules.

What documentation is needed for compliant CCM billing?

Providers must document all care management services, evidence of care plan establishment or updates, time spent, and patient consent in the electronic health record (EHR).

How does CCM improve patient outcomes?

CCM helps care continuity, encourages people to stick to their care plans, makes it easier to reconcile medications, increases communication between providers, and in the end, leads to better long-term health outcomes.

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