Chronic Care Management Codes: Billing Guide for Providers

Chronic care management codes help healthcare providers support care for Medicare patients. These patients live with more than one chronic condition. The codes also help providers bill for care services. This allows them to follow value-based care models. The codes can improve patient health. They also help reduce hospital visits. Monthly revenue is another benefit for providers.

This guide explains how chronic care management works. It also shares billing rules, digital tools, and important recordkeeping steps. Providers can use this to set up or manage a CCM program with confidence.

What Is Chronic Care Management (CCM)?

Chronic Care Management is a paid Medicare service. It is for patients with at least two chronic conditions. These conditions must last for 12 months or longer. The service does not require in-person visits. It focuses on planned care between office visits.

Doctors, nurse practitioners, and physician assistants can bill for CCM. Nurses and medical assistants can help. They must work under the provider’s supervision. CCM must include an electronic care plan. It must also manage medications and help during care transitions.

Key Features of CCM

Care is managed by doctors, nurse practitioners, or physician assistants.
Clinical staff may assist under proper supervision.
Plans must include health issues, prescriptions, and care steps.

Eligibility, Enrollment, and Consent

Patients need to meet specific criteria. They must have two or more long-term health conditions. These include diabetes, arthritis, COPD, or heart disease. The conditions must last at least one year or for the rest of their lives.

Before starting CCM, the provider must see the patient. This can be done during a Wellness Visit or checkup. The patient must agree to receive CCM services. The provider must ask for consent. Consent may be verbal or written. The provider must document this in the patient’s record. Patients must also know about the 20% coinsurance.

Required Documentation

Care Plan: Lists health problems, goals, medicines, and care steps
Communication: Shows that the patient knows how to contact the care team
Activity Notes: Records calls, medication updates, referrals, and hospital follow-ups

Chronic Care Management Codes: Structure and Billing

Providers must know how to bill chronic care management codes. These codes are based on time spent and who gives the care. The table below explains the most common codes and how they work.

Code	Description	Time Needed	Estimated Payment (2024)
99490	Non-complex CCM by clinical staff	20 minutes	$60
99439	Extra 20 minutes added to 99490	20 minutes	$48
99487	Complex CCM with higher-level care needs	60 minutes	$135
99489	Extra 30 minutes added to 99487	30 minutes	$70
99491	CCM is done by a physician or a nurse practitioner	30 minutes	$82
99437	Extra 30 minutes added to 99491	30 minutes	$75

Only one provider can bill for CCM each month. The provider must track the time spent. That time cannot be shared across codes. For example, 99491 cannot be billed in the same month as 99487, 99489, or 99490.

Providers can bill CCM with other services. This includes some remote services. Time must be recorded correctly and not counted twice.

Using Technology in Virtual Chronic Care Management

Virtual Chronic Care Management uses digital tools. These tools help care teams connect with patients between visits. They support follow-ups and reminders. They also let teams send updates about care plans.

Telehealth visits allow short video check-ins. Phone calls and messages can also help. Mobile apps and portals are used to send alerts. These alerts may include medication reminders or test results.

Examples of Virtual Tools

Telehealth: Patients get short video visits with staff
Portals: Patients can see their care plans or send messages
Mobile apps: Patients can share symptoms or health data.

Remote Care Management and Monitoring

Remote care management adds extra support for CCM. It includes devices that track patient data at home. This may include blood pressure monitors or glucose meters. These tools send health data to the EHR.

That data helps providers take action. They can change care plans or contact patients sooner. It supports safer and quicker care changes. Remote therapy monitoring is also helpful. This is used during recovery or physical therapy. It tracks patient progress using digital tools.

Key Technologies

Remote Patient Monitoring tracks blood pressure and glucose levels.
Remote Therapy Monitoring supports patients during recovery.
Health data is used to change care plans when needed.

Working with a Chronic Care Management Company

Some clinics work with a chronic care management company. These companies offer extra staff. They also provide tools that work with clinic systems.

They can call patients, update records, and manage follow-ups. This helps clinics save time. But the billing provider must still stay involved. CMS expects providers to review each care plan. They must check if tasks are complete. They also need to make sure records meet CMS rules.

Services a CCM Company May Offer

Licensed care coordinators for regular calls
Software that connects with your EHR
Help with consent, care plans, and billing records

Conclusion

Chronic Care Management Codes help providers support Medicare patients with long-term health needs. Clear care plans and frequent follow-ups are important. Tools like RPM and remote care management systems also help.

Working with a chronic care management company can reduce workload. But providers must review all records and care plans. Providers should also follow CMS updates. These updates include new codes and rules. By doing this, they can bill correctly and offer better care.