Empower Chronic Care Management with FairPath
Your expert guide to CCM billing codes, compliance, and patient coordination in 2025.
Your CCM Foundation
What Is Chronic Care Management?
Chronic Care Management (CCM), launched by Medicare in 2015, supports patients with two or more chronic conditions through non-face-to-face care coordination—think phone calls, care plan updates, and medication management. CCM enhances outcomes by ensuring 24/7 access to a care team, fostering continuity for conditions like diabetes or heart disease.
FairPath's guide unpacks CCM's billing codes, compliance rules, and technology, giving you the tools to streamline care and reimbursement in 2025.
Decoding CCM Billing
Understanding CCM CPT Codes
Medicare's CCM CPT codes vary by staff involvement, complexity, and time spent. Here's your 2025 breakdown:
CPT™ 99490: Non-Complex CCM
Clinical Staff, First 20 Minutes
- Description: 20+ minutes of clinical staff time monthly, supervised by a physician/QHP.
- Requirements: Care coordination; comprehensive care plan in a certified EHR.
- Eligible Providers: Physicians, NPs, PAs, CNSs, CNMs; staff under general supervision.
- Documentation: Log exact time (e.g., "3/15: 10-min call, 10-min med review").
- Payment: ~$60 (2025 estimate).
Common Question: "What if I log 19 minutes?" You can't bill—20 is the strict minimum.
CPT™ 99439: Additional Staff Time
Add-on Code
- Description: Add-on for each extra 20 minutes beyond 99490.
- Requirements: Full 20-minute increments; medically necessary tasks.
- Documentation: Specify additional efforts (e.g., "20-min specialist consult").
- Payment: ~$45 per unit (2025 estimate).
Common Question: "Can I bill for 35 minutes?" Yes—99490 + one 99439 (up to 40 min total).
CPT™ 99491: Non-Complex CCM
Physician/QHP, 30 Minutes
- Description: 30+ minutes by a physician/QHP personally—no staff time counts.
- Requirements: Cannot mix with 99490 in the same month.
- Documentation: Physician time only (e.g., "30-min care plan update").
- Payment: ~$80 (2025 estimate).
Common Question: "Can staff help?" No—99491 is physician/QHP-only.
CPT™ 99437: Additional Physician/QHP Time
Add-on Code
- Description: Add-on for each extra 30 minutes beyond 99491.
- Requirements: Full 30-minute increments; physician-driven.
- Payment: ~$55 per unit (2025 estimate).
Common Question: "Is there a cap?" No, but justify every minute.
CPT™ 99487: Complex CCM
60 Minutes
- Description: 60+ minutes of staff time with moderate/high complexity MDM.
- Requirements: Intensive care plan revisions; complex decisions.
- Documentation: Detail complexity (e.g., "60-min med adjustment, specialist sync").
- Payment: ~$130 (2025 estimate).
Common Question: "What's complex enough?" Significant changes or multi-provider coordination.
CPT™ 99489: Additional Complex Time
Add-on Code
- Description: Add-on for each extra 30 minutes beyond 99487.
- Requirements: Sustained complexity; full increments.
- Payment: ~$70 per unit (2025 estimate).
Common Question: "Can I bill without complexity?" No—MDM must support it.
HCPCS G0506: Initiating Visit Add-On
One-time Fee
- Description: One-time fee for extra care planning during an E/M visit (e.g., AWV).
- Requirements: Bill with initiating visit; document added effort.
- Payment: ~$65 (2025 estimate).
Common Question: "Is it monthly?" No—just once at CCM enrollment.
Key Rules
- Requires patient consent, two chronic conditions, and one billing provider monthly.
- Stackable with RPM or TCM if time is distinct; no overlap with PCM or home health oversight.
Tech That Transforms
Tools for CCM Excellence
Technology powers CCM:
Certified EHR
Required for structured care plans and data sharing; logs time/tasks.
CCM Platforms
Solutions like ThoroughCare or ChartSpan track minutes, build care plans, and sync with EHRs.
Communication
Phone, secure messaging, and portals count toward billable time.
AI Innovation
Tools analyze data for risk stratification or suggest actions—but human staff time is what bills.
Common Question: "Can AI chatbots count?" No—only clinical staff time qualifies.
Best Practice: Use dashboards to monitor 20+ minutes monthly per patient.
Protecting Your Practice
Navigating CCM Compliance
CCM faces scrutiny—stay compliant:
Time Accuracy
Log 20+ minutes precisely; no double-counting with TCM/RPM.
Care Plan
Must be comprehensive, updated, and EHR-accessible.
Consent
Document patient agreement and cost-sharing notice—verbal or written.
Fraud Risks
OIG audits flagged $1.8M in overpayments (2015–2016) for insufficient time or missing elements.
Outsourcing
Third-party CCM vendors need fair-market-value contracts to avoid Anti-Kickback issues.
Common Question: "What if I forget consent?" Claims can be recouped—always document.
Tip: Self-audit monthly with logs like "3/15: 10-min call, med review."
Who Pays for CCM?
Medicare, MA, Medicaid, and Private Coverage
Medicare Part B
Covers all codes; 20% coinsurance (often offset by Medigap/Medicaid).
Medicare Advantage (MA)
Matches Medicare; many plans offer $0 copays to boost use.
Medicaid
14+ states cover CCM (e.g., Colorado mirrors Medicare); rates vary (~$40 for 99490).
Private Insurers
Aetna, BCBS often pay; Cigna lags. Rates differ (e.g., $50–$65 for 99490).
Common Question: "Will my payer cover it?" Verify policies—Medicare sets the standard.
Trend: Commercial adoption grows as CCM proves cost savings.
Timing Your Claims
How CCM Billing Cycles Work
CCM operates on a calendar-month cycle:
Base Codes (99490, 99491, 99487):
Bill once monthly after meeting time thresholds, typically using the last day (e.g., March 31).
Add-Ons (99439, 99437, 99489):
Add as needed for extra time in that month.
G0506:
Bill once with the initiating visit.
Common Question: "What if I start mid-month?" Bill for that month if thresholds are met by month-end (e.g., 20+ min by March 31).
Tips:
Track time daily; bill only when requirements are fully met.
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