Chronic Care Management (CCM) uses codes 99490 (first 20 minutes per month), 99439 (each additional 20 minutes), 99487 (complex CCM, 60 minutes), and 99489 (additional 30 minutes). Eligibility requires a patient with 2 or more chronic conditions expected to last 12+ months. Examples: diabetes plus hypertension, CHF plus COPD, diabetes plus depression. Patient must consent to enrollment, documented in the EHR. Only one provider bills CCM per patient per month. Medicare pays $42-64 per patient per month at the 99490 level; complex CCM (99487) pays higher. CCM includes care planning, monitoring, coordination with specialists, and transitional care services outside of office visits.
Bill 99490 once per patient per month (includes up to 20 minutes of care coordination). Bill 99439 for each additional 20-minute block beyond the first. Complex CCM (99487, for higher-acuity patients requiring 60+ minutes monthly care coordination) is billed once; 99489 is used for each additional 30-minute block. Select the appropriate code based on estimated monthly care coordination time. Activities include: assessing medication adherence, coordinating specialist referrals, reviewing lab results, addressing barriers to care, transitional care from hospital, and managing complex medical and psychosocial conditions. The service is non-face-to-face and can occur via phone, EHR, or office visit.
CCM does not require prior authorization by Medicare or most commercial payers. However, enrollment must be documented with patient consent. Once enrolled, patients can be billed monthly automatically. Patients may opt out at any time. Some plans limit CCM enrollment based on patient population (e.g., only patients 65+, only those meeting certain HCC criteria). Verify coverage with each patient's plan before enrollment. Payers audit CCM billing for time justification—ensure care coordination activities are documented monthly to support billing.
CCM is not bundled with office E/M visits or other services. The patient can be billed for CCM in a month when they also have an office visit. Do not apply modifiers to CCM codes. If a patient transitions from CCM to complex CCM (99490 to 99487), bill both codes on different dates if the upgrade occurs mid-month. Only one provider per patient per month bills CCM. If a patient sees multiple providers in the same group, designate one primary provider for CCM billing to avoid duplicate claims.
Document patient consent for CCM enrollment (date and method: written, phone, office). Maintain a monthly care coordination log showing care manager activities: medication review, adherence checking, specialist coordination, lab/imaging review, barrier identification, transitional care planning. Identify the 2+ chronic conditions managed. Document time spent on care coordination (target 20+ minutes for 99490, 60+ minutes for 99487). Include communication with specialists, pharmacy, hospital discharge planners, or other care team members. Track outcomes: patient engagement, adherence improvement, reduction in hospital readmissions or ED visits. Monthly documentation is required for billing—do not bill CCM without evidence of care coordination in that month.
Do not bill CCM during inpatient hospital stays. Resume CCM billing 30 days after discharge. If the patient is discharged and seen in clinic within 30 days, transitional care management (99495, 99496) codes apply instead of CCM for the first 30 days post-discharge. Coordinate with hospital discharge planning to avoid billing overlap.
Yes. The provider can serve as the care coordinator. Care coordination activities (medication review, specialist communication, adherence monitoring) can be performed by the provider, RN, or other staff. Document the activities regardless of who performs them. The billing provider is responsible for oversight.
Document the reason for upgrade (increasing complexity, additional comorbidities, worsening disease control). Bill 99487 instead of 99490 in the month of upgrade, ensuring monthly care coordination time reaches 60+ minutes. Most payers allow seamless transition; notify the payer if required.
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