What is Chronic Care Management?
Chronic Care Management (CCM), provided by Medicare, refers to various support services tailored towards those suffering from various chronic health conditions spanning at least a year or until death occurs in an individual. CCM plays an integral role in treating these diseases requiring continuing monitoring beyond traditional visits to healthcare specialists.
Who can get the benefits from CCM?
People living with at least two serious chronic diseases most often use Consumer Care Management Assistance (CCM) services. Such people typically need additional support in regulating their health, this may involve monitoring medication intake and symptom management, as well as coordination among various health professionals.
The role of the Centers for Medicare & Medicaid Services (CMS):
The CMS takes great pride in being on the cutting edge of chronic care management (CCM). CMS recognizes CCM’s integral place within primary healthcare, emphasizing its significance by offering continuing care that enhances patients’ quality of life while decreasing overall healthcare costs through effective implementation. CCM not only improves health and quality outcomes, but it can also lower overall costs associated with care, offering proactive primary healthcare that prevents costly treatments earlier rather than later.
- The Centers for Medicare & Medicaid Services (CMS) aims to improve the quality of life for patients with chronic conditions.
- Through integration, patients receive essential healthcare promptly and efficiently.
- This initiative not only helps patients manage their conditions more effectively but also assists the larger health system.
- These projects aim to alleviate pressure on medical facilities and decrease hospital readmission rates.
Understanding CCM CPT coding for Chronic Care Management
- Chronic Care Management (CCM) services play an integral part in taking care of Medicare beneficiaries who live with multiple chronic diseases.
- Healthcare providers utilize Current Procedural Terminology (CPT) codes in order to bill for services they render.
- CPT codes correspond with various levels of service provided and ensure healthcare providers receive equitable compensation for their efforts.
Here’s a breakdown of the five primary CPT codes used for reporting CCM services:
| CPT Code | Service Description | Time | Additional Notes |
| 99490 | Non-complex CCM involving coordination of care across providers and supporting patient accountability. | 20 minutes | Basic code for non-complex CCM. |
| 99439 | Additional time for non-complex CCM. | Each additional 20 minutes | Must be billed in conjunction with CPT code 99490. |
| 99487 | Complex CCM that includes substantial revision or establishment of a comprehensive care plan. Involves moderate- to high-complexity medical decision making. | 60 minutes | For more intricate and involved care needs. |
| 99489 | Additional time for complex CCM. | Each additional 30 minutes | Must be reported with CPT code 99487; cannot be billed with CPT code 99490. |
| 99491 | CCM services provided personally by a physician or other qualified health care professional. | At least 30 minutes | Emphasizes direct involvement from higher-level professionals. |
Chronic Care Management (CCM) & Principal Care Management Codes:
| CPT Code | Descriptor | Medicare Fee 2024 |
| 99424 | Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month | $82.55 |
| 99425 | Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) | $59.92 |
| 99426 | Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month | $61.91 |
| 99427 | Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month (List separately in addition to code for primary procedure) | $47.27 |
| 99437 | Chronic care management services, provided personally by a physician or other qualified health care professional, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised or monitored; each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) | $59.58 |
| 99439 | Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month | $47.93 |
| 99487 | Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, establishment or substantial revision of comprehensive care plan, moderate or high complexity medical decision making; first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month | $134.15 |
| 99489 | Complex chronic care management services, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, establishment or significant revision of comprehensive care plan, moderate or high complexity medical decision making; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) | $72.23 |
| 99490 | Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month | $62.58 |
| 99491 | Chronic care management services, provided personally by a physician or other qualified healthcare professional, at least 30 minutes of physician or other qualified healthcare professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored | $84.55 |
Complex and Components for Chronic Care Management (CCM):
Chronic Care Management (CCM) and Complex CCM are vital services for Medicare beneficiaries suffering from numerous chronic illnesses. Both of these services require detailed documentation within the Electronic Health Record (EHR) and are governed by particular requirements and components that must be completed.
Documentation Requirements for CCM Services:
- Continuous monitoring and needed changes in treatment strategies.
- Working with other health professionals to warrant the complete care of patients.
- Routine assessment and administration of medication for patients.
- Evaluation of the health status of patients to guide health care choices.
Non-complex CCM (CPT Code 99490) Requirements
- Patients must have at minimum two (2) chronic illnesses which are expected to last 12 months or more, or up to the end of the patient’s life.
- Consent needs to be obtained from the patient in writing or verbally.
- A comprehensive care plan should be recorded in an electronic health record that is certified (EHR) and the plan should be provided to the person receiving it.
- Access to 24/7 for patients the team of care for any urgent medical needs.
- There should be enhanced non-face-to face communication channels among the patient as well as health care team.
- Effective management of shifts between various care settings or healthcare facilities.
- A minimum of 20 minutes each calendar month for clinical staff time should be allocated to non-face-to face chronic care management (CCM) services under the supervision by a physician or another competent health care competent.
Chronic Care Management Services Provided by a Physician or Other Qualified Healthcare Professional (CPT Code 99491)
Personal Time Requirement: At least 30 minutes should be dedicated each month by physicians and other certified healthcare experts to care management.
Complex CCM (CPT Code 99487) Requirements:
Complex CCM offers some of the same specifications as standard CCM but may differ due to special requirements:
Service Time: Every month, clinical staff provides at least 60 minutes of treatment time including making decisions and being present during decision making processes.
Medical Decision Making: Medical decisions range from being simple and straightforward, to complex.
Eligible Health Care Professionals:
One physician or other qualified healthcare professional can assume health care responsibility of managing beneficiaries and billing for CCM services to them within any specific calendar month. Clinical staff may assist in this provision but billing must be handled solely by certified healthcare professional professionals. Here is the list of professionals capable of performing billing:
Physician: Medical doctors supervise various aspects of patient care.
Clinical Nurse Specialist (CNS): Advanced practice nurses specialize in improving both patient care standards and outcomes within clinical practice settings.
Nurse Practitioner (NP): Registered nurses with postgraduate studies training who offer healthcare services focused on health promotion are known as registered nurse specialists.
Physician Assistant (PA): Professionals licensed to practice medicine under the direction of a licensed doctor.
Certified Nurse Midwife: Nurse midwives offer women various health services that include the gynecological exam as well as family planning assistance and prenatal health care.
Legal Requirements for Non-Physicians:
Non-physician practitioners must obtain legal permission and license from each state where services are rendered in order to adhere to CCM practices that meet national standards as well as adhere to state regulations regarding healthcare services.
Frequently Asked Questions (FAQ):
What’s the difference between codes 99490 and 99491?
Yes, both CPT codes 99490 and 99491 can be utilized to treat chronic conditions (CCM). However, they differ according to criteria: CPT code 99490 must be utilized at least 20 hours each month under medical supervision by clinical personnel while 99491 requires at least 30 minutes with direct delivery by an expert healthcare practitioner or provider.
How do I bill for chronic disease management?
Chronic Care Management, more often known by its acronym CCM, utilizes specific billing codes based on the services rendered; such as CPT 99490, 99487 99489 99491 which provide long-term or complex coordination care services provided for those suffering chronic illnesses. Each CPT code represents different lengths or complexity levels of services coordinated care services delivered.
What exactly does CCM code 99491 entail?
CPT code 99491 describes chronic care management services provided directly by a doctor or qualified health care worker to an individual with multiple chronic illnesses requiring comprehensive healthcare management for at least 30 minutes each month, but with no alternative sources providing timely healthcare management care services. If this CPT code cannot provide timely healthcare management care services it could be considered for reimbursement purposes.
Can you explain what CPT code 99490 is used for?
Clinical teams led by physicians or qualified health providers may use CPT code 99490 to identify chronic care management services requiring at least 20 minutes a month of non-face-to-face coordination; such services could involve overseeing medication oversight, reviewing patient records with healthcare providers, coordinating care responsibilities among others tasks.
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