List of Chronic Care Management Cpt Codes & Billing Guide in 2025 - 2026

Chronic Care Management (CCM) patients help patients manage multiple chronic conditions and generate recurring revenue for their practices. The Centers for Medicare & Medicaid Services (CMS) pay for these essential services, which include medical guidance 24/7, monthly patient consultations, and transportation and medication refill logistics help.

Various CPT codes for multiple aspects of care delivery make up CCM billing, which is famously complex. To avoid incorrect billing and the loss of your practice’s hard-earned recurring income, it is important to understand these differences.

This article will go over the most common CCM CPT codes utilized for Chronic Care Management services in 2024, as well as the requirements for eligibility, in detail. We will also talk about ways a full-service CCM company can improve billing processes and get more money back.

6 Most Famous CPT Codes Used to Bill Chronic Care Management (CCM) Services in 2024 

Each kind of CCM has its own unique CPT billing code. Most importantly, eligibility is determined by who provides program services, how difficult medical decisions are to make, and the amount of time someone spends with the patient.

Overview:

1. CPT Code 99490:

Standard 20 Minutes of CCM Services, covers non-face-to-face care coordination services, focusing on managing chronic conditions.

2. CPT Code 99491:

Initial 30 Minutes of CCM Care Provided by a Physician or Nurse Practitioner represents more comprehensive care, focusing on time-based management.

3. CPT Code 99487:

Used for complex chronic care management, particularly when extensive coordination is needed.

4. CPT Code 99437: 

Extra 30 Minutes of CCM Care Offered by a Doctor or Nurse Practitioner

5. CPT Code 99489:

An add-on code for additional time spent on complex CCM services.

6. CPT Code 99439:

20-additional minutes (Non-Complex, limit 2)

What is CPT Code 99490?

CPT Code 99490 is designed for non-complex Chronic Care Management services. It allows healthcare providers to bill for at least 20 minutes of clinical staff time spent on managing patients with multiple chronic conditions within a calendar month. But what does that mean in practical terms?

Who Can Benefit?

To qualify for billing under this code, patients must have two or more chronic conditions that are expected to last at least 12 months or until their death. These conditions should also pose a significant risk of complications, such as:

• Death
• Acute exacerbation
• Decompensation
• Functional decline

This means that if you or someone you know is living with chronic health issues, CPT 99490 could be a key component in ensuring they receive the ongoing care they need.

The Importance of Care Plans

One of the critical aspects of CPT 99490 is the requirement for a comprehensive care plan. This plan must be:

• Established
• Implemented
• Revised
• Monitored

This ensures that all aspects of a patient’s health are considered, and care is coordinated across various healthcare disciplines. It’s not just about treating symptoms; it’s about creating a holistic approach to health management.

Billing and Reimbursement Insights

For healthcare providers, understanding how to bill for CPT 99490 is essential for maintaining practice revenue while providing quality care.

How Often Can You Bill?

CPT 99490 can be billed once per month for each eligible patient. This means that if you have multiple patients who meet the criteria, there’s an opportunity to enhance your practice’s revenue stream while ensuring your patients receive the necessary support.

What About Reimbursement Rates?

The national average reimbursement rate for CPT 99490 is approximately $42.84. While this may vary based on location and specific payer contracts, it provides a baseline for what providers can expect when billing for these services.

Supervision Requirements

One of the great features of CPT 99490 is that clinical staff can provide these services under the general supervision of a physician or qualified healthcare professional. This means that while the physician doesn’t need to be present during the service, they must be available to offer direction and oversight.

Comparing CCM Codes

CPT 99490 isn’t the only code in the CCM toolbox. Here are some other related codes you might encounter:

• CPT 99491: This code requires 30 minutes of personal time spent by a physician or qualified healthcare professional and can be billed in conjunction with CPT 99490.
• CPT 99439: An add-on code that allows billing for each additional 20 minutes of clinical staff time beyond what is covered under CPT 99490.

What is CPT Code 99491?

CPT Code 99491 is unique in its focus on direct care provided by physicians and qualified healthcare professionals. Unlike other CCM codes that allow clinical staff to deliver services under physician supervision, this code requires a minimum of 30 minutes of personal time spent by the physician or QHP each month.

Who Can Benefit?

To qualify for billing under CPT 99491, patients must have two or more chronic conditions that are expected to last at least 12 months or until their death. These conditions should also pose significant risks, such as:

• Acute exacerbation
• Decompensation
• Functional decline

By meeting these criteria, patients can receive the personalized attention they deserve from their healthcare providers.

The Importance of Care Coordination

One of the key aspects of CPT 99491 is its emphasis on care coordination. The services covered under this code include establishing, monitoring, revising, or implementing a comprehensive care plan tailored to the patient’s specific needs. This holistic approach ensures that all aspects of a patient’s health are considered, leading to better outcomes and reduced complications.

Reimbursement Details

For healthcare providers, understanding the financial implications of CPT 99491 is crucial for maintaining a sustainable practice while delivering high-quality care.

How Much Can You Expect?

The national average reimbursement for 99491CPT Code is approximately $86.17 per month. While this rate may vary based on regional differences and specific payer contracts, it provides a solid foundation for practices to build upon.

Billing Frequency

CPT 99491 can be billed once per month for each eligible patient. This means that if you have multiple patients who meet the criteria, there’s an opportunity to enhance your practice’s revenue stream while ensuring your patients receive the necessary support.

Comparing CCM Codes

While CPT 99491 is a powerful tool in its own right, it’s essential to understand how it fits into the broader landscape of CCM codes. Here are some key comparisons:

• CPT 99490: This code allows for billing when clinical staff provide care coordination under the supervision of a physician, requiring only 20 minutes of time.
• CPT 99439 and CPT 99437: These are add-on codes that allow billing for additional time spent beyond the initial requirements of CPT 99490 and CPT 99491, respectively.

Empowering Patients

By utilizing CPT Code 99491, healthcare providers can empower their patients to take an active role in managing their chronic conditions. Through personalized care plans and regular check-ins with their physicians or QHPs, patients can gain a better understanding of their health and develop strategies to maintain their well-being.

What is CPT Code 99439?

CPT Code 99439 is billed for each additional 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month. This code is specifically used after the initial 20 minutes billed under CPT 99490, which covers the first segment of non-complex chronic care management.

Key Features:

• Add-On Nature: CPT 99439 serves as an add-on to CPT 99490, allowing providers to bill for extra time spent on care coordination beyond the initial 20 minutes.
• Billing Limitations: Providers can bill for up to two units of CPT 99439 in conjunction with CPT 99490 in a single calendar month, which means a total of 60 minutes can be billed if both the initial and additional time segments are utilized.

Reimbursement Details

Financial Aspects:

• Reimbursement Rate: The national average reimbursement for CPT Code 99439 is approximately $46.28 per month. This may vary based on regional differences and specific payer contracts.

When to Report:

CPT 99439 can be reported when additional care beyond the initial time covered by CPT 99490 is provided. It is essential that all services rendered are documented appropriately to support billing.

Importance in Chronic Care Management

CPT Code 99439 plays a crucial role in enhancing care coordination for patients with chronic conditions. By allowing healthcare providers to bill for additional time spent managing these patients, it encourages more comprehensive and continuous care. This can lead to improved patient outcomes, as providers can spend more time addressing the complex needs of their patients.

What is CPT Code 99437?

CPT Code 99437 is billed for each additional 30 minutes of chronic care management services provided by a physician or other qualified healthcare professional (QHP) beyond the initial time covered under CPT Code 99491. This code is specifically designed for situations where more time is necessary to manage complex patient needs.

Key Features:

• Add-On Nature: CPT 99437 serves as an add-on to CPT 99491, which requires at least 30 minutes of personal time spent by a physician or QHP. Thus, if a provider spends 60 minutes or more with a patient, they can bill for one unit of CPT 99437 in addition to CPT 99491.
• Patient Eligibility: To utilize this code, patients must have two or more chronic conditions that are expected to last at least 12 months or until their death. These conditions should also place the patient at significant risk of complications.

Reimbursement Details

Financial Aspects:

• Reimbursement Rate: The national average reimbursement for CPT Code 99437 is approximately $61.00 per month. This rate may vary based on regional differences and specific payer contracts.

Billing Frequency:

CPT 99437 can be billed for each additional 30 minutes of care provided beyond the initial period covered by CPT 99491. Providers should ensure that all services rendered are well-documented to support billing.

Importance in Chronic Care Management

CPT Code 99437 plays a vital role in enhancing care coordination for patients with chronic conditions. By allowing healthcare providers to bill for additional time spent managing these patients, it encourages comprehensive and continuous care. This can lead to improved patient outcomes, as providers can spend more time addressing the complex needs of their patients.

What is G0511?

HCPCS code G0511 is a general care management code specifically designed for RHCs and FQHCs. It covers 20 minutes or more of clinical staff time per calendar month for chronic care management (CCM) services or behavioral health integration (BHI) services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM).

Key Features:

• Applicable to RHCs and FQHCs only
• Can be billed multiple times per month for different services like CCM, RPM, RTM, etc.
• Separate requirements must be met for each service billed (e.g. 16 days of RPM data for RPM)
• Associated costs for each service must be accounted for separately

By understanding these features, RHCs and FQHCs can optimize their use of G0511 to provide the best possible care for their patients.

The Power of Care Management

One of the most significant advantages of G0511 is its ability to support comprehensive care management services. By covering a range of interventions, including chronic care management and behavioral health integration, this code enables RHCs and FQHCs to address the diverse needs of their patients.

Chronic Care Management:

G0511 allows RHCs and FQHCs to provide coordinated, patient-centered care for individuals with multiple chronic conditions. By establishing comprehensive care plans and regularly monitoring patient progress, providers can help patients manage their health more effectively, reducing the risk of complications and improving overall quality of life.

Behavioral Health Integration:

Mental health is an integral part of overall well-being, and G0511 recognizes this by covering behavioral health integration services. RHCs and FQHCs can use this code to provide integrated care, ensuring that patients receive the mental health support they need alongside their physical health care.

Reimbursement Insights

For RHCs and FQHCs, understanding the financial implications of G0511 is crucial for maintaining a sustainable practice while delivering high-quality care.

Reimbursement Rates:

The 2023 national average reimbursement rate for G0511 is $77.94 per month. While this rate may vary based on regional differences and specific payer contracts, it provides a solid foundation for RHCs and FQHCs to build upon.

Billing Frequency:

G0511 can be billed multiple times per month for different care management services. This means that if an RHC or FQHC provides a range of interventions, there’s an opportunity to enhance their revenue stream while ensuring their patients receive the necessary support.

What is 99487 CPT Code?

CPT Code 99487 is used to bill for complex chronic care management services. This code is applicable when a patient has two or more chronic conditions that require moderate to high complexity medical decision-making. It allows healthcare providers to receive reimbursement for the first 60 minutes of non-face-to-face care coordination performed by clinical staff under the direction of a physician or other qualified healthcare professional (QHP).

Key Requirements:

To successfully bill under CPT 99487, several criteria must be met:

• Multiple Chronic Conditions: The patient must have at least two chronic conditions that are expected to last 12 months or longer.
• Significant Risk: These conditions should put the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.
• Comprehensive Care Plan: There must be an establishment or substantial revision of a comprehensive care plan tailored to the patient’s needs.
• Moderate to High Complexity Medical Decision-Making: The medical decision-making involved must meet moderate to high complexity standards.

The Financial Side of CPT 99487

Reimbursement Insights:

For healthcare providers, understanding the financial implications of CPT 99487 is crucial for maintaining a sustainable practice while delivering high-quality care. The national average reimbursement for this code is approximately $134.27 per month. However, this amount may vary based on regional differences and specific payer contracts.

Billing Frequency:

CPT 99487 can be billed once per calendar month, making it essential for providers to document their services accurately. It’s important to note that this code cannot be reported concurrently with non-complex CCM codes like CPT 99490 or 99491 for the same patient in the same month.

Why Is CPT 99487 Important?

CPT Code 99487 plays a vital role in enhancing care coordination for patients with complex chronic conditions. Here are some key benefits:

Improved Patient Outcomes

By utilizing CPT 99487, healthcare providers can offer structured care management that helps prevent complications and improve overall health outcomes for patients facing multiple health challenges. This proactive approach can lead to better management of chronic conditions and a higher quality of life for patients.

Financial Support for Providers

The reimbursement associated with CPT 99487 provides essential financial support for healthcare providers, allowing them to sustain their practices while delivering high-quality care. This financial backing encourages providers to invest time and resources into managing complex cases effectively.

What is 99489CPT Code?

CPT Code 99489 is used to bill for each additional 30 minutes of complex CCM services provided by clinical staff under the direction of a physician or other qualified healthcare professional (QHP). This code is specifically applicable after the initial 60 minutes covered by CPT Code 99487.

Key Features:

• Add-On Code: CPT 99489 is an add-on code that must be reported in conjunction with CPT 99487, which covers the first 60 minutes of complex CCM services.
• Time Requirement: It allows for billing additional time spent on care coordination beyond the initial hour, specifically for each additional 30 minutes of service.
• Patient Eligibility: To qualify for billing under CPT 99489, patients must have two or more chronic conditions that are expected to last at least 12 months or until death, and these conditions must pose significant risks such as exacerbation or functional decline.

Reimbursement Details

Financial Aspects:

The national average reimbursement for CPT Code 99489 is approximately $70.60 per month. This amount may vary based on regional differences and specific payer contracts.

Billing Frequency:

CPT 99489 can only be billed after the initial 60 minutes provided under CPT 99487, making it crucial for healthcare providers to document the total time spent on care coordination accurately.

Importance in Chronic Care Management

CPT Code 99489 plays a vital role in supporting comprehensive care management for patients with complex chronic conditions. Here are some key benefits:

Enhanced Patient Care

By allowing providers to bill for additional time spent on care coordination, CPT 99489 encourages a more thorough approach to managing patients’ health needs. This can lead to improved health outcomes and a better quality of life for patients facing multiple chronic issues.

Financial Support for Providers

The reimbursement associated with CPT 99489 provides essential financial support for healthcare providers, enabling them to allocate more resources toward managing complex cases effectively.

Chronic Care Management Billing Guidelines

What do you need to send CMS CCM claims?

• Patient permission: Verbal or written permission that has been recorded.
• Care Plan: Comprehensive and updated regularly.
• Tracking time: Keeping accurate records of the time spent caring for patients.

What do you need to know about Chronic Care Management (CCM) and how it bills?

Providers can keep patients interested in CCM once a month, in between normal appointments.CCM can be given over the phone or through a telehealth tool. It is billed when at least 20 minutes are spent doing the right things with the patient.

As examples of CCM services,

• A professional review every month
• Calls to cell phones
• Doctor looks over
• Referrals
• Filling up prescriptions
• Review of charts
• Setting up services or meetings

For a patient to be eligible for CCM, they must have two or more long-term conditions that are projected to last at least one year. The patient’s doctor must also write down these symptoms 12 months before enrolment. They have to pose a big chance of death, serious illness, or loss of function.

When a patient joins CCM, an individualized care plan is made for them, with their help, and it lists the services that will be provided. The goals, health background, and behavior of the patient are all written down in these care plans. Part B of Medicare pays for 80% of this benefit for people.

Who is Capable of Providing CCM?

Providers with an NPI number must tell CCM how to bill. However, professional staff can run most of the program, saving doctors time and effort. Eligible providers are:

• Doctors
• Nurse practitioners
• Nurses who work as
• A registered nurse midwife
• Specialists in nursing care
• Pharmacists
• Putting in claims for Medicare

What Should You Need When you send in a Medicare claim?  you need five things:

1. CPT numbers for each patient program you are in charge of
2. There are ICD-10 codes for each of the conditions you are managing in that app.
3. When the service took place
4. Location of the service (usually an office or online)
5. The number for the National Provider Identifier (NPI)

In case of an audit, knowing which staff care supervisor is in charge of a certain patient is helpful.

How to Bill for CCM in Four Steps?

1. Every month, make sure that CMS standards are met for every patient.
2. Send monthly claims to CMS
3. Send a bill to people who get monthly CCM services
4. Check to see if any billing codes that don’t match up have been used.

Comprehensive Chronic Care Management (CCM) Integrated with RPM

Some providers can give both CCM and RPM. Patients can record their information on digital devices, like a blood glucose monitor, and use it to help manage their condition.
There are special CPT billing codes for RPM that can be used with CCM billing codes to get two types of refunds. However, RPM’s service and time needs must be met separately from CCM’s. This is also true for health clinics in rural areas and health centers that are government-qualified. However, these groups have to use the HCPCS code G0511.

This page has more information about RPM billing numbers.

Integrating Behavioral Health into CCM:

Providers can also combine CCM with BHI. Medicare recipients can get help with their mental health every month through BHI, a care management program. When combined with CCM, integrated behavioral health helps a collaborative care approach that can raise outcomes and lower costs.

BHI can use its own CPT billing code along with CCM. But all of BHI’s work and time needs must be met separately from CCM.

rural health clinics (RHCs) and federally approved health centers (FQHCs) also have to follow this rule when they use HCPCS code G0511. Find out more about BHI billing numbers here.

CCM’s Potential for Making Money

Care management tools can help healthcare organizations make money and cut costs. Here is a general example of how the money you get back for a CCM program could add up.

Value-based care is pushed by CCM.

In addition to direct reimbursement, CCM programs offer other perks to providers. They can be made better so that they report data, keep patients interested and motivated, and meet quality standards that are important for value-based care.

People who use CCM are more involved in their care and it helps to organize care. By planning your own care, you can make SMART goals and keep track of them, or you can learn about the social factors that affect health.

Patients who have access to a care manager and are more involved in their care are better off. They meet once a month to ask questions, talk about conditions, and get tools.

Just by charging certain CPT codes, a CCM program can make a lot of money. However, some parts of the program can also support a value-based care approach, especially when used in a bigger healthcare system.

Vital Health Services makes it easier for Chronic Care Management:

Vital Health Services gives Chronic Care Management workflow from start to finish. We make the process easier so that providers can focus on getting people involved. These things do Vital Health Services:

• Complete tools for planning care
• Assessments based on facts (lifestyle, health risks, behavioral factors, SDOH)
• giving out payment codes automatically and keeping track of changes
• Putting together data from EHRs, HIEs, remote devices, and advanced care plans
• Analytics will be used to report on business and care performance