Chronic Care Management
CPT Codes

This is a basic code for CCM, which covers at least 20 minutes of clinical staff time (as directed by a physician or other qualified healthcare professional) in a given month. For patients with two or more chronic conditions:

• Care must be managed by a physician or qualified health professional
• Requires a comprehensive plan of care via a digital health platform
• Billed once a month, per patient

This code can be billed in addition to 99490 if care management time exceeds 20 minutes, along with the regular 20 minutes of staff time within the same calendar month. This code reimburses providers for more intensive care coordination delivered to a patient.

Unlike 99490, this code reimburses for direct care coordination time provided by a physician or qualified health professional (QHP), rather than time spent by clinical staff:

• Requires a minimum of 30 minutes of the physician/QHP's time in a calendar month.
• Reimburses at a higher rate than staff-based codes.
• Billed once per patient per month.

When the physician or QHP has provided CCM services for more than 30 minutes in a calendar month, this additional code can be used for billing the care management provided for each additional 30 minutes.

This code applies specifically to patients with complex needs that require additional time and/or a higher level of medical decision-making:

• Patients require at least 60 minutes of clinical staff time in a calendar month.
• Moderate or high complexity medical decision making must be involved.
• Changes to care plans or more intensive management for complex conditions must be made.

This add-on should be reported when complex CCM exceeds the initial 60 minutes. Each unit or clinical session reported represents an additional 30 minutes of clinical staff time under the supervision of a physician. This code must always be billed in conjunction with CPT Code 99487.