Chronic Care Management CPT Codes

Updated: January 29, 2024

Chronic Care Management represents a critical component of primary care that contributes to better health and care for individuals with chronic conditions. The introduction of Chronic Care Management CPT codes by the Centers for Medicare & Medicaid Services (CMS) has revolutionized the billing process for these services, allowing healthcare providers to be reimbursed for the time and resources they invest in managing chronic care patients outside of face-to-face appointments.

What is Chronic Care Management (CCM)?

Chronic Care Management refers to the coordination of care outside of the regular clinic setting for patients living with multiple chronic conditions. These services often include continuous patient monitoring, medication management, and coordination with other healthcare professionals, aimed at enhancing the patient’s quality of life and health outcomes.

What are the Chronic Care Management (CCM) CPT Codes?

CCM Codes

  • CPT99490: Minimum 20 cumulative minutes over a 30-day period of non-face-to-face time monitoring the care plan.
  • CPT99491: Initial 30 minutes of care personally provided by physician, or non-physician practitioner (NPP).

CCM Add-On Codes

These codes are used in conjunction with the primary Chronic Care Management codes for additional service time provided in a month.

  • CPT99439: Subsequent 20 minutes of care provided by clinical staff. Add-on to CPT 99490.
  • CPT99437: Subsequent 30 minutes of care personally provided by a physician or NPP. Add-on to CPT 99491.

Complex CCM Codes

Complex CCM codes are designed for patients who require more extensive care coordination and management services due to the complexity of their health conditions.

  • CPT99487: Minimum 60 cumulative minutes over a 30-day period of non-face-to-face consultation time establishing or monitoring a care plan.

CCM Complex Add-On Code

These codes are used for additional time spent on complex CCM services beyond the primary billed services.

  • CPT99489: To be billed with CPT 99487 for every additional 30 minutes of non-face-to-face consultation.

Key Requirements for Billing CCM CPT Codes

To ensure proper billing for Chronic Care Management services, specific requirements must be met:

  • Establishing a Care Plan: Creating a comprehensive care plan for each patient.
  • Implementing the Plan: Actively carrying out the established care plan.
  • Revising the Plan: Updating the care plan as needed based on patient conditions.
  • Monitoring: Regularly monitoring the effectiveness and relevance of the care plan.

What are the Key Chronic Care Management (CCM) Service Elements?

Effective Chronic Care Management involves several critical service elements:

  • Structured Recording: Maintaining detailed records of patient health information.
  • Comprehensive Care Planning: Developing thorough care plans tailored to each patient’s needs.
  • Care Transition Management: Overseeing patient transitions between care settings or providers.
  • Coordination with Providers: Collaborating with home and community-based clinical service providers.

Benefits of using TextExpander for CCM CPT Codes

TextExpander’s snippets and template library significantly enhances the efficiency of coding Chronic Care Management CPT codes. With our text expansion app, you’re able to:

  • Automate Expansions of Abbreviations: Instantly transform short abbreviations into full CPT codes, saving time and reducing typing effort.
  • Increase Accuracy: Reduce errors associated with manual code entry, ensuring higher accuracy in coding.
  • Streamline Documentation: Simplify the process of documenting patient encounters and care plans.
  • Enhance Productivity: Allow healthcare providers to focus more on patient care rather than administrative tasks.
  • Improve Billing Efficiency: Facilitate quicker and more accurate billing, potentially leading to more timely reimbursements.

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Minimum 20 cumulative minutes over a 30-day period of non-face-to-face time monitoring the care plan.
Initial 30 minutes of care personally provided by physician, or non-physician practitioner (NPP).
Subsequent 20 minutes of care provided by clinical staff. Add-on to CPT 99490.
Minimum 60 cumulative minutes over a 30-day period of non-face-to-face consultation time establishing or monitoring a care plan.
To be billed with CPT 99487 for every additional 30 minutes of non-face-to-face consultation.

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