Chronic Care Management (CCM) CPT Codes & Requirements

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. 

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.