Chronic Care Management (CCM) isn’t just a service, it’s a strategic opportunity for healthcare providers to enhance patient outcomes and increase revenue. In 2023, over 5.7 million CCM services were billed, reflecting a 23% increase from the previous year, with approximately 1.3 million patients and 16,000 providers participating.
As of 2025, CMS has introduced new CPT codes, such as 99490 and 99439, with reimbursement rates of $60.49 and $45.93 per 20 minutes of non-complex care, respectively.
Expansion in this includes the ruler health clinic (RHCs) and Federally Qualified Health Centers (FQHCs), which allows them to bill CCM services directly. It is very necessary to embrace these to align with the value-based care models but also position practices to go forward in the evolving healthcare landscape.
What Is Medical Billing For Chronic Care Management (CCM)?
Medical billing for chronic care management is the process of submitting claims and following up on them for the services that have been provided by the provider to patients with chronic conditions. This is how healthcare providers get reimbursed for the time they spend managing and coordinating care for patients with chronic disease.
Difference Between Complex and Non-Complex Chronic Care Management (CCM)
Chronic Care Management (CCM) services are designed to support patients with long-term health conditions. These services are categorized into non-complex and complex based on the severity of the patient’s conditions and the level of care coordination required. Here’s how the two differ:
Non-Complex CCM:
Involves less intensive care coordination for patients with chronic conditions that don’t require high levels of clinical intervention or frequent monitoring.
Examples: Conditions like well-managed hypertension, asthma, or diabetes without severe complications.
Care Activities: Includes basic activities like medication management, phone calls, follow-up visits, and general care plan oversight.
CPT Codes: 99490 (20 minutes of non-complex care coordination) and 99439 (additional 20 minutes).
Complex CCM:
Requires more intensive care coordination for patients with multiple chronic conditions that require frequent monitoring and more extensive clinical intervention.
Examples: Conditions like heart failure, COPD with frequent flare-ups, or diabetes with complications like neuropathy.
Care Activities: Involves comprehensive care planning, coordination across multiple healthcare providers, and frequent monitoring of the patient’s health.
CPT Codes:
- 99487: At least 60 minutes of complex care coordination
- 99489: Additional 30 minutes of complex care coordination
| Feature | Non-Complex CCM | Complex CCM |
| MDM Level | Straightforward or low | Moderate to high |
| Time Requirement | 20–60 minutes | 60–90 minutes |
| Care Coordination | Basic | Comprehensive |
| Billing Practitioner | Can be clinical staff under supervision | Requires direct involvement of physician or qualified healthcare professional |
| Reimbursement | Lower | Higher |
Chronic Care Management CPT Codes
Chronic Care Management (CCM) services are essential for patients with multiple chronic conditions, offering structured care coordination that can enhance patient outcomes and provide additional revenue streams for healthcare providers. In 2025, the Centers for Medicare & Medicaid Services (CMS) updated the reimbursement rates for CCM services, reflecting the increasing value placed on these services.
| CPT Code | Service Description | Reimbursement |
| 99490 | Non-complex CCM services (at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional) | $60.49 |
| 99439 | Each additional 20 minutes of non-complex CCM services | $45.93 |
| 99491 | Non-complex CCM services (at least 30 minutes of care provided personally by a physician or other qualified healthcare professional) | $82.16 |
| 99437 | Each additional 30 minutes of non-complex CCM services provided personally by a physician or other qualified healthcare professional | $57.58 |
| 99487 | Complex CCM services (at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional) | $131.65 |
| 99489 | Each additional 30 minutes of complex CCM services provided by clinical staff under the direction of a physician or other qualified healthcare professional | $70.52 |
What Is The Eligibility Criterion For Chronic Care Management (CCM)?
Patients must have a minimum of two chronic diseases to be eligible for the chronic care management (CCM) program.
| Category | Conditions |
|---|---|
| Cardiovascular & Blood | Hypertension, Heart Ischemia, Heart Attack, Stroke, Anemia, Atrioventricular Fibrillation |
| Respiratory | Asthma, COPD |
| Psychiatric & Neurological | Alzheimer’s, Dementia, Depression, Cancer, Osteoarthritis, Rheumatoid Arthritis |
| Eye Disorders | Cataract, Glaucoma |
| Additional Conditions | Hypothyroidism, Kidney Disease, Diabetes, Obesity |
| Mental Health | PTSD, Anxiety, Bipolar, Schizophrenia, Autism, Epilepsy, Chronic Migraines |
| Substance Use | Alcohol, Opioids, Nicotine, Other Drugs |
| Immune Conditions | HIV/AIDS, Hepatitis, Multiple Sclerosis |
| Blood Disorders | Leukemia, Lymphomas, Vascular Disease |
| Musculoskeletal | Spinal Injury, Chronic Pain, Fibromyalgia |
| Organ Disorders | Cirrhosis, Cystic Fibrosis |
| Other Disabling | Developmental Delays, Intellectual Impairments, Vision or Hearing Loss |
Guidelines for Chronic Care Management Billing:
The CCM billing guidelines mention the requirements for billing these essential services, including eligibility, consent, services, and billing procedures. This section provides an overview of CMS and commercial payer guidelines, covering eligibility, consent, service scope, time requirements, billing codes, and reimbursement to help practices bill accurately for CCM services.
Billing for Chronic Care Management (CCM) services involves several key requirements:
- Face-to-Face Visit: A qualifying visit with the billing practitioner establishes eligibility, consent, and care planning.
- Non Face-to-Face Services: Remote activities such as phone calls, chart reviews, and care coordination count toward the required time.
- Consent: Patients must provide written or verbal consent, documented by the billing practitioner.
- Certified Billing Practitioner: Only the provider managing the patient’s care can bill for CCM services. Nurse practitioners, PAs, and clinical nurse specialists can also provide CCM services.
- Patient Eligibility: CCM is for patients with two or more chronic conditions expected to last at least 12 months, placing them at high risk of decline.
- Minimum Time Requirement: A minimum amount of time spent on care coordination is required to bill for CCM services.
- Supervision of Staff: The billing practitioner must oversee all clinical staff involved in CCM services, but staff cannot bill independently.
Claim Submission Process For CCM Services To CMS:
Submitting Chronic Care Management (CCM) claims to CMS, healthcare providers need to ensure that they check the patient eligibility, proper documentation, and correct CPT code selection. This process involves verifying patient consent, and recording all CCM activities. Claims are then submitted with the appropriate CPT codes, ICD-10 codes, date of service, place of service (usually the provider’s office), and the provider’s NPI number.
Gather Required Information
Before submitting your Chronic Care Management (CCM) claim, make sure to collect all necessary details:
- Accurate CPT codes for the services provided.
- Complete records of all care coordination activities.
- Patient demographics (name, DOB, etc.).
- Insurance information, including Medicare number or policy details.
Select the Correct Claim Form
Use the CMS-1500 form, designed specifically for professional services. Ensure all fields are completed accurately to avoid processing delays.
Submit Your Claim Efficiently
For optimal results, submit your claim electronically through a Certified Electronic Health Record Technology (CEHRT) or a clearinghouse. If electronic submission is not possible, paper submission is an alternative.
Track Your Claim Status
After submission, monitor your claim’s status via the Medicare Provider Portal or by contacting your insurance payer. This helps identify any issues early and allows for timely follow-up.
Address Claim Denials
If your claim is denied, review the denial reason carefully. If it’s due to an error or missing documentation, correct it and resubmit. For unjustified denials, consider appealing with additional supporting evidence.
Final Thought:
Chronic Care Management (CCM) presents a valuable opportunity for healthcare providers to improve patient care and revenue. With updated CPT codes and expanded access to services for RHCs and FQHCs, it’s essential to follow accurate billing guidelines. As the demand for CCM rises, staying informed on eligibility, coding, and time tracking ensures effective billing and timely reimbursement. By embracing CCM, practices can deliver better outcomes and align with value-based care models, all while maximizing revenue.
Unlock Your Revenue Potential with Efficient CCM Billing
Ready to resolve billing issues and optimize revenue for your practice? Don’t let claims get stuck. Contact us today to ensure smooth Chronic Care Management (CCM) billing and timely reimbursements!
References:
- CCM Growth: Over 5.7 million CCM services were billed last year—a 23% increase.
- Chronic Illness Impact: CDC reports 42% of U.S. adults have at least one chronic condition; 12% have five or more.