Chronic Care Management (CCM) CPT Codes For Billing

The non-face-to-face Chronic Care Management (CCM) services are provided to Medicare beneficiaries who have two or more chronic conditions that are anticipated to endure for a minimum of a year or until the patient's death.

The Centers for Medicare and Medicaid Services (CMS) acknowledge the importance of CCM services as foundational elements of primary care that enhance overall health and reduce health care costs. Through distant connections, CCM enables doctors and healthcare institutions to continue treating patients.

Medicare will pay for the CCM program as long as patient care is rendered for at least 20 minutes each month. A patient must have two or more chronic illnesses in order to be eligible for CCM, and the doctor must disclose any chronic conditions the patient has had for the 12 months preceding to CCM participation.

CPT Codes For CCM Billing

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

1. CPT Code 99490

This non-complex CCM, which has a $64 reimbursement rate, is a 20-minute timed service offered monthly by clinical staff to improve patient accountability and treatment coordination among clinicians. The following criteria must be fulfilled:

• It is anticipated that a patient with several chronic conditions will live for at least a year or until they pass away.

• Chronic illnesses that increase a patient's risk of dying, experiencing an acute flare-up, or experiencing a functional deterioration.

• A thorough care plan was created, put into action, adjusted, and kept track of.

2. CPT Code 99439

This code is an add-on to 99490 and is charged in addition to it. Each extra 20 minutes of clinical staff time under the direction of a doctor or other qualified health care professional is reimbursed at a rate of $48 per calendar month for chronic care management services code 99439.

3. CPT Code 99491 

CCM services must meet certain criteria in order to be paid for $86, and they must be performed in person for at least 30 minutes each calendar month by a doctor or other licensed health care provider.

• It is anticipated that a patient with several chronic conditions will live for at least a year or until they pass away.

• Chronic illnesses that increase a patient's risk of dying, experiencing an acute flare-up, or experiencing a functional deterioration.

• A thorough care plan was created, put into action, adjusted, and kept track of.

4. CPT Code 99437 

A $61 reimbursement is provided for this 99491 add-on code. A licensed healthcare practitioner, clinician, or physician provides 30 minutes of additional time for chronic care management services each month for billing.

Requirements For Non-complex CCM

The requirements for non-complex CCM include:

• Verbal or signed agreement from the patient; 

• a personalized care plan and a copy of the EHR are given to the patient; 

• two or more chronic conditions anticipated to endure for at least a year or until the patient's death;

• a member of the care team is always accessible to patients in need;

• Managing care transitions and settings; 

• facilitating non-face-to-face communication between patients and doctors; 

• dedicating at least 20 minutes of clinical staff time each calendar month to non-face-to-face CCM services under the supervision of a doctor or other competent healthcare professional;

• care management services need at least 30 minutes of personal time, and CCM services are documented using CPT number 99491.

Utilize HealthArc's Virtual Monitoring Services to Simplify CCM

Our comprehensive virtual monitoring solutions include a suite of FDA-approved remote monitoring devices, patient communication, clinical software, physician dashboard, and digital billing capabilities for delivering effective CCM services. 

To find out how we can assist your healthcare organization in achieving its non-complex chronic care management objectives, kindly request a free demo. Please contact our team at +201 885 5571 if you have any questions concerning the CCM codes.