CCM CPT Codes and 2023 Reimbursement Rates

Chronic Care Management (CCM) is a service provided to individuals enrolled in Medicare who have multiple chronic conditions. Healthcare providers utilize CPT codes to report these services for reimbursement purposes.

There are chronic care management billing requirements that healthcare providers must meet to fulfill Chronic Care Management billing guidelines:

Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. Here is a link to some examples in Medicares chronic condition data warehouse.
Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
A patient comprehensive care plan established, implemented, monitored or revised.

CPT Codes and Reimbursement Rates

The term Chronic Care Management includes various services that encompass a broad base of patient-centered care management. These services include Chronic Care Management (CCM), Principal Care Management (PCM), and Transitional Care Management. CCM also includes Remote Physiologic Monitoring (RPM) and Integrated Behavioral Health Services.

Each of these chronic care management reimbursement solutions has associated CPT codes for billing. It is important to understand what codes to use for unlocking chronic care management billing opportunities. The following sections review the Chronic Care Management (CCM) specific codes and physician fee schedules.

Common Chronic Care Management CPT Codes

The common CCM CPT codes, along with their corresponding Medicare reimbursement rates for 2023 are the following:

CPT 99490: Code for monthly chronic care management services. These services require 20 minutes of clinical staff time per calendar month. A doctor or qualified healthcare professional can complete the required time. The 2023 reimbursement rate is approximately $62.69.
Code CPT 99487: Code for complex chronic care management services. The first 60 minutes of clinical staff time completed by a physician or other qualified healthcare professional per calendar month. The 2023 reimbursement rate is approximately $133.18.
CPT 99489: Code for an additional 30 mins of complex, chronic care management services. staff time(after the first 60 minutes) completed by a doctor or qualified healthcare professional each month. The 2023 reimbursement rate is approximately $70.49.
CPT Code 99491: Code for the initial complex, chronic care management services. It requires 30 minutes of time by only the billing practitioner per calendar month. This code requires the providers to personally provide care. The 2023 reimbursement rate is approximately $85.06.

Reimbursement rates may differ based on factors such as insurance payment policies and geographic location. Keep in mind, private payers may have different reimbursement rates or may not cover CCM services at all.

Please refer to the Centers for Medicare and Medicaid Services (CMS) for the most accurate reimbursement rates. You can also contact your local Medicare Administrative Contractor (MAC) or private insurance providers for the current rates.

Difference Between CPT Code 99490 and CPT Code 99491 for Chronic Care Management Billing

CPT Code 99490 and CPT Code 99491 differ in terms of time and complexity for providing Chronic Care Management services. Please note the contrast below:

CPT Code 99490: This CPT code bills the standard or non-complex CCM service. It requires 20 minutes of clinical staff time overseen by a doctor or other qualified healthcare professional each calendar month. This code is for patients with multiple chronic conditions who need continuous care management and coordination.
CPT Code 99491: This CPT bills for complex CCM services. It covers 30 minutes of only the billing practitioner’s time per calendar month. This code requires the providers to personally provide care. Patients with multiple conditions require a higher level of care management and coordination due to the complexity of their chronic conditions.

To summarize, CPT Code 99490 corresponds to standard CCM services with at least 20 minutes of clinical staff time. On the other hand, CPT Code 99491 is for complex CCM services with an initial 30 minutes of only provider time. Choosing the appropriate code depends on the complexity of the patient’s chronic conditions and time required to provide the care. Most of all, it depends on if the provider is personally providing the care.

CCM Add-On Codes: CPT 99439 and CPT 99437

Add-on codes will pay for additional time completed by a provider or qualified clinical staff per calendar month. The scope of service requirements remain the same. Please note the list and requirements below:

CPT code 99439: 99439 billing guidelines cover an additional 20 minutes of non-complex CCM services. Only bill this code after the initial 20 minutes billed under CPT Code 99490. If there is 60 minutes or more of non-complex CCM staff time per calendar month, 99439 CPT Code pays x2. 99439 reimbursement allows for additional clinical staff time beyond the initial 20 minutes billed as 99490.
CPT code 99437: 99437 billing guidelines cover each additional 30 minutes or more of complex CCM services. Only bill this code after the initial 30 minutes billed under CPT code 99491. This code requires time provided personally by a provider, either a physician or qualified health care professional. This allows for the reimbursement of additional provider time beyond the initial 30 minutes.

Both these add-on codes bill once per calendar month.

CCM Complex Codes: CPT 99487 and CPT 99489

There are two complex care chronic care management codes, CPT 99487 and CPT 99489. Physicians and health care professionals use these codes for patients with multiple chronic conditions. These conditions require moderate to complex medical decision making.

Complex codes involve the establishment, implementation, revision, or monitoring of a comprehensive care plan. Healthcare professionals tailored this care plan to the specific needs of the patient. Providers focus on managing complex health conditions and make informed decisions for better patient outcomes.

Please note the comparison between the two complex codes:

CPT code 99487 Initial Complex: 99487 is the initial code for complex chronic care management services. The first 60 minutes of clinical staff time overseen by a physician or other qualified healthcare professional per calendar month.
CPT code 99489 Add-on Complex: 99489 is the add-on code for complex chronic care management services. Providers can charge for an additional 30 minutes of time per month. This is after the first 60 minutes of code 99487.

When to Report CPT 99489

Report CPT 99489 when you have met the time requirement of 60 minutes for CPT Code 99487. When a patient receives at least 90 minutes or more of CCM services in a month, report CPT 99489. CPT 99489 provides reimbursement for extra time spent on providing comprehensive care and coordination for patients with complex chronic conditions.

CCM Care Planning Codes: HCPCS G0506 and CPT 99487

There are two codes used for billing the comprehensive assessment and care planning for patients eligible for Chronic Care Management services. Providers use HCPCS code G0506. RN Care Managers, directed by the provider, use CPT Code 99487. The explanation of the two codes follow.

HCPCS G0506 – Provider Care Planning Code

The initial assessment evaluates the patient’s medical health, chronic disease history, and current conditions. It also creates a personalized care plan that addresses their specific healthcare needs.
If a provider starts the care plan during the patient’s visit, they can finish it afterwards. When complete, the provider can then bill for the CPT code G0506.
The reimbursement rate for this service would pay the provider $62.01.

CPT Code 99489 – Add-On Code

If the RN Care Manager develops and completes the care plan upon the provider’s direction, the provider needs to approve. This approval includes provider’s review, making any needed changes, and signing the care plan.
The provider can then bill CPT code 99487 for the initial 60-89 minutes of comprehensive care planning.
The provider can charge the add-on code if care planning lasts 90 minutes or more. For example, if a comprehensive care plan takes 103 minutes to complete, bill 99487 (first 60 minutes). Also bill 99489 (additional minutes once 90 minutes is met).
The reimbursement rate for this service would pay the provider $70.49 (The National Payment Amount).

CPT 99487 – RN Care Planning Code

If the RN Care Manager develops and completes the care plan upon the provider’s direction, the provider needs to approve. This approval includes provider’s review, making any needed changes, and signing the care plan.
The provider can then bill CPT code 99487 for the initial 60-89 minutes of comprehensive care planning.
The reimbursement rate for this service would pay the provider $133.18 (The National Payment Amount).

Improving CCM Coding Compliance with CareVitality

Improve CCM coding compliance effectively with CareVitality. Simplify and optimize your coding practices through our comprehensive solution, ensuring accurate and effective Chronic Care Management (CCM) coding. Experience streamlined workflows, accuracy, and enhanced documentation, resulting in improved healthcare outcomes. Elevate your coding compliance seamlessly with CareVitality CCM software solution and/ or CCM services.