Chronic Care Management (CCM)

For many years, physicians have helped patients over the phone and behind the scenes, but never got paid for this time; it is about time for physicians to get paid for such help, and now they can. Introducing CCM by Medicare.

What is CCM? CCM, or Chronic Care Management, is defined as the non-face-to-face services provided to Medicare patients who have two or more chronic conditions. In addition to office visits and other face-to-face encounters (billed separately), these services include communication with the patient and other treating health professionals for care coordination (electronically such as by phone, email, text, patient portal, etc…), medication management, and being accessible 24 hours a day to patients and any care providers (physicians or other clinical staff). 

How does CCM work? The designated CCM clinician (MD, PA, NP) must establish, implement, revise, or monitor and manage an electronic care plan that addresses the physical, mental, psychosocial, functional, and environmental needs of the patient as well as maintain an inventory of resources and supports that the patient needs. Thus, the practice must use a certified EHR to bill CCM codes.

Who can bill for CCM? Patients can elect one physician to take care of their CCM program. Only one clinician can bill for any particular patient, therefore it may be necessary for the billing CCM physician to coordinate with the sub-specialists who may be providing a significant amount of care and treatment to one or more of the patient’s conditions. 

What CPT code can you bill for CCM? 99490 – The current year average reimbursement is about $42.60 per month per patient. The practice must have the patient’s written consent in order to bill for CCM services. The practice needs to document 20 minutes of non-face-to-face clinical staff time per month. 

Lets’s do the math: the practice can earn about $500 per year per patient; if you have 100 patients participating that will result in about $50,000; 500 patients = $250,000 of additional income from the CCM program.
  • CPT 99490  $42.22
  • New CPT 99487 $92.66
  • New CPT 99489 $46.87
  • New Add-On Initiation Code GPPP7 $63.68
How can you get started with the CCM program? Give us a call and we can help! 800-955-0321 option 1