Your team spends countless hours on the phone with patients, coordinating with specialists, and managing complex care plans. This work is essential for keeping your patients with chronic conditions healthy, but is your practice getting paid for it? Too often, this non-face-to-face care goes unbilled, creating a strain on your resources. This is where understanding Chronic Care Management (CCM) CPT codes changes the game. They are the mechanism that turns your valuable, non-face-to-face care into a reliable, recurring revenue stream. This guide will walk you through exactly how to use these codes to get compensated for the critical work you’re already doing.
Think of Chronic Care Management (CCM) CPT codes as the language you use to bill for the essential, non-face-to-face care you provide to patients with multiple chronic conditions. These aren't just random numbers; they are specific codes that represent the time and effort your team spends creating care plans, coordinating with other specialists, and managing medications between office visits. Essentially, they allow you to get reimbursed for the crucial work that keeps your patients healthier and out of the hospital.
CCM services are a cornerstone of modern healthcare, especially for practices managing patients with conditions like hypertension, diabetes, or heart failure. Using the right CPT (AKA "Current Procedural Terminology") codes ensures that your practice is compensated fairly for this ongoing care. It’s about recognizing the value of continuous patient management and making it a sustainable part of your practice. By understanding and using these codes correctly, you can build a successful CCM program that supports both your patients' health and your practice's financial stability.
For your practice, CPT codes are the key to billing for your CCM services. Each code corresponds to a specific amount of time spent on care management and the complexity of the patient's case. For example, you’ll use one code for 20 minutes of basic care coordination and a different set of codes for more intensive work involving complex medical decision-making. The system is designed to be flexible, allowing you to bill accurately for the level of service you provide each month. Getting familiar with the main CCM codes helps ensure you capture all billable time and avoid compliance issues.
Many practices struggle to navigate these billing nuances on their own. That’s why 1bios builds billing best practices and real-time CPT code guidance directly into our platform—and backs it with a U.S.-based team that supports every claim. Our customers don’t just understand the codes—they get paid accurately, every time.
Properly using CCM codes does more than just keep your billing in order—it directly impacts your practice's revenue and patient care. These codes create a valuable, recurring revenue stream for the care coordination your team is likely already providing. By billing for these services, you can fund program growth, hire dedicated care managers, and invest in better technology. More importantly, it validates the effort you put into proactive patient management. This focus on continuous care leads to better health outcomes, higher patient satisfaction, and a stronger, more resilient practice. It’s a clear win for both your patients and your bottom line.
Offering a structured CCM program brings a host of benefits beyond just new revenue. First and foremost, it leads to better patient care by providing a framework for proactively managing chronic conditions. This consistent oversight helps reduce hospital readmissions and emergency room visits. It also improves communication, ensuring that all providers involved in a patient's care are on the same page. Furthermore, a strong CCM program positions your practice for success in value-based care models, where you’re rewarded for positive patient outcomes, not just the volume of services rendered.
Getting your practice paid for the valuable care you provide shouldn’t feel like solving a puzzle. When it comes to CCM, understanding the right CPT codes is the key to successful reimbursement. These codes tell payers exactly what services you’ve provided, ensuring you’re compensated for the time your clinical staff spends managing patient care between office visits. Think of this as your go-to guide for the essential codes you’ll use to build and sustain a successful CCM program. We’ll break down what each code covers, when to use it, and what you need to do to ensure every claim is clean and compliant.
Think of CPT 99490 as the foundational code for your non-complex CCM services. This code covers the first 20 minutes of non-face-to-face time your clinical staff spends on a patient’s care each calendar month. To qualify, your patient needs to have two or more chronic conditions that are expected to last at least a year or until the end of their life. These conditions must also place the patient at significant risk of decline or decompensation. The work billed under this code includes developing care plans, coordinating with other providers, and managing medications—all done remotely via phone or a patient portal. It’s the most frequently used code and the starting point for billing your CCM program.
When a patient's needs become more involved, you move into the territory of complex CCM. CPT 99487 is used to bill for the first 60 minutes of a clinical staff member’s time on complex cases. This typically involves patients with conditions that require more difficult medical decision-making. If the care extends beyond that first hour, you can use the add-on code CPT 99489 for each additional 30-minute increment. These codes acknowledge the extra effort required to manage patients with escalating health issues, ensuring your practice is fairly compensated for the intensive oversight and coordination involved in their care.
Before you can begin billing for monthly CCM services, you need to formally onboard the patient. That’s where CPT G0506 comes in. This is an add-on code used for the comprehensive assessment and care planning you perform during the initiating visit for new CCM patients. This can be a face-to-face visit, like an Annual Wellness Visit, or a separate encounter dedicated to explaining the CCM program, obtaining patient consent, and establishing their care plan. Think of it as the official kick-off for their enrollment in your program. It’s a one-time code that sets the foundation for all future CCM services you provide.
To bill accurately, you need to track every minute your clinical staff spends on qualifying CCM activities. This time isn't limited to direct phone calls with the patient. You can and should count time spent communicating with caregivers, coordinating with other healthcare professionals, creating and revising care plans, and providing patient education.
Proper documentation is non-negotiable for a compliant and audit-proof CCM program. First, you must create a comprehensive, patient-centered care plan for each enrolled individual. This document should be created by or under the direct supervision of a physician. Second, you absolutely must obtain and document the patient's consent to participate in the program. According to the official Chronic Care Management Services fact sheet from CMS, this consent must be kept in their record for 10 years. Meticulous record-keeping not only ensures you meet all requirements but also protects your practice and proves the value of the care you’re delivering.
(At 1bios, every interaction—care plan creation, patient consent, staff activity, and communication—is automatically tracked in an audit-ready format. That means your practice always has the documentation it needs to stay compliant and confidently submit claims—even during payer audits.)
To bill accurately, you need to track every minute your clinical staff spends on qualifying CCM activities. This time isn't limited to direct phone calls with the patient. You can and should count time spent communicating with caregivers, coordinating with other healthcare professionals, creating and revising care plans, and providing patient education. Each billing code has a minimum time requirement—like 20 minutes for CPT 99490—so precise tracking is essential. Using a reliable system to log these activities as they happen prevents lost minutes and ensures you can bill for the full scope of work your team performs each month, which is crucial for running a successful CCM program.
Understanding eligibility rules is the first step to creating a program that generates revenue and improves patient outcomes. While Medicare formalized the CCM program, many Medicare Advantage (MA) and commercial plans also reimburse for these services, so the same CPT codes often apply across payers. It’s about meeting specific criteria for patient conditions, securing their consent, and ensuring your practice can bill correctly. Getting these foundational pieces of your CCM services right from the start prevents compliance headaches and helps you focus on the patients who can truly benefit.
The primary requirement for CCM is straightforward: a patient must have two or more chronic conditions expected to last at least 12 months or until the end of life. These aren’t temporary issues—qualifying conditions must carry a significant risk of decline, exacerbation, or death if not properly managed.
CCM services and the CPT codes that support them are most commonly associated with Medicare, but they are also reimbursed by Medicare Advantage (MA) plans and many commercial insurance providers. That means practices can leverage CCM billing codes across a broad patient population, depending on payer coverage.
Having two chronic conditions is just the starting point; their severity also matters. To qualify, the patient's illnesses must place them at significant risk of death, acute exacerbation, or a functional decline. These are serious conditions that require proactive management to prevent a patient’s health from worsening. Common examples include Alzheimer's, arthritis, asthma, cancer, cardiovascular disease, and diabetes. For cardiology or endocrinology practices, this often means patients with hypertension, heart failure, or diabetes, who need continuous care to maintain their quality of life.
Your practice also has a few key requirements. The CCM program must be overseen by a qualified healthcare professional with a National Provider Identifier (NPI), like a physician or nurse practitioner. A crucial rule to remember is that only one provider can bill for a patient's CCM services in any given month. This prevents duplicate billing and ensures care is coordinated through a single practice. Before enrolling a patient, it’s a good practice to confirm they aren’t receiving CCM from another provider to avoid any issues.
You can’t enroll a patient in CCM without their permission. Patient consent is mandatory and must be documented in their medical record, though it can be given verbally or in writing. During the conversation, explain what CCM services involve and mention that cost-sharing may apply. You also need to inform the patient that only one practice can provide CCM each month and that they can stop services at any time. Documenting this discussion is essential for compliance and helps build a trusting relationship, a core part of effective CCM.
When you're building a CCM program, you'll quickly see that not all patient care is the same. That's why CCM services are split into two main categories: non-complex and complex. Understanding the nuances between them is key to providing the right level of care for your patients and ensuring your practice is billing correctly. The primary differences come down to the amount of time you spend, the complexity of medical decisions, and the overall intensity of the care management your patient requires. Let's break down what sets these two service levels apart.
At its core, the distinction between non-complex and complex CCM is about the level of engagement a patient needs. Both services are designed for Medicare patients with two or more chronic conditions that are expected to last at least a year. Non-complex CCM is your standard service for patients whose conditions are relatively stable. You're providing ongoing management, but you aren't dealing with major flare-ups or complications.
Complex CCM, on the other hand, is for patients who require more intensive support. This could be due to a significant exacerbation of their condition, a new diagnosis that complicates their existing care plan, or a situation where their health is declining. It reflects a higher level of clinical effort needed to manage their care effectively and prevent further complications or hospitalizations.
One of the most concrete ways to distinguish between non-complex and complex CCM is by looking at the clock. The CPT codes have specific time minimums for the non-face-to-face care your clinical staff provides each month. For non-complex CCM, billed under CPT code 99490, you need to document at least 20 minutes of care management activities.
For complex CCM, the time commitment is significantly higher. CPT code 99487 requires at least 60 minutes of clinical staff time per calendar month. This time can include developing care plans, coordinating with specialists, medication management, and communicating with the patient or their family. Accurately tracking this time is not just a billing requirement—it’s a reflection of the deeper involvement needed for your more vulnerable patients.
Beyond just the time spent, the nature of your clinical judgment is a major factor. Non-complex CCM involves routine care management, whereas complex CCM is defined by the need for moderate to high-complexity medical decision-making. So, what does that actually mean for your practice? It means you're grappling with more challenging clinical situations.
This could involve establishing or revising a care plan for a patient whose condition has suddenly worsened, making difficult decisions about new medications with potential side effects, or managing a patient who isn't responding to the current treatment. It’s about handling the gray areas of patient care where the path forward isn't straightforward. This level of clinical decision-making is a key qualifier for billing for complex CCM services.
Properly coding for complex CCM doesn't just ensure compliance; it also ensures your practice is fairly compensated for the extra work involved. The reimbursement rates from Medicare reflect the significant difference in time and clinical intensity between the two service levels. While rates can vary by location, the national average for non-complex CCM (CPT 99490) is typically around $60.
In contrast, the reimbursement for complex CCM (CPT 99487) is substantially higher, with an average payment of about $134. This difference acknowledges the additional resources your practice dedicates to managing patients with more severe or unstable conditions. Getting your CCM billing right means you can sustain your program and continue providing this vital care to the patients who need it most.
Solid documentation is the backbone of any successful CCM program. It’s what ensures you get paid for your hard work and proves you’re providing excellent, coordinated care. Getting your documentation right from the start saves you major headaches down the line, especially if you ever face an audit. Think of it less as paperwork and more as the story of your patient's care journey. Let’s walk through the essential practices to keep your program compliant and running smoothly.
A comprehensive care plan is more than a checklist; it's a dynamic roadmap for your patient's health.
A comprehensive care plan is more than a checklist; it's a dynamic roadmap for your patient's health. According to CMS guidelines, this plan must be developed by or under the supervision of a physician. It should detail the patient's health problems, expected outcomes, treatment goals, and medication management. It’s also crucial that this plan is shared with the patient and any other clinicians involved in their care. This keeps everyone on the same page and ensures a truly collaborative approach to managing their chronic conditions.
When it comes to technology, there’s one rule you can’t bend: your practice must use a certified Electronic Health Record (EHR) to bill for CCM services. This is a firm requirement for participation. However, if you partner with a CCM service, their team isn't required to document their time directly in your EHR. This separation can significantly simplify your internal workflows, as your partner can manage their documentation on their own platform while providing you with the necessary reports for billing and oversight.
Let’s keep billing simple. You can submit your CCM claims once per calendar month for each enrolled patient. The key is to wait until the end of the service period to bill for the time spent during that month. A critical rule to remember is that you cannot bill for both non-complex and complex CCM for the same patient within the same month. You have to choose the code that accurately reflects the level of service provided. Sticking to this rule helps prevent claim rejections and keeps your billing process clean and predictable.
Staying compliant means being aware of how CCM interacts with other services. Medicare has specific rules about billing CCM alongside other programs. For instance, you cannot bill for CCM if you are also billing for services like home health supervision or Transitional Care Management for the same patient in the same month. It’s essential to have a process in place to check for these potential overlaps before submitting claims. Regularly reviewing each patient's billed services for the month is a simple but effective way to ensure you meet all Medicare rules and maintain an audit-ready program.
Launching a CCM program is a fantastic step toward better patient outcomes and a healthier revenue stream for your practice. But let's be real—it also comes with a few operational hurdles. From tracking every minute to keeping documentation pristine, it’s easy to feel overwhelmed. The good news is that these challenges are completely manageable with the right strategies in place. Think of this as your playbook for smoothing out the bumps in the road so you can focus on what truly matters: caring for your patients. By anticipating these common issues, you can build a program that is not only compliant and profitable but also sustainable for your team in the long run.
If it wasn’t documented, it didn’t happen. This is the golden rule of CCM. For every service you bill, you need a clear and detailed record in the patient's chart. This includes everything from updating care plans and managing prescriptions to coordinating with specialists and checking in with the patient. Meticulous documentation is your best defense in an audit and the key to getting paid correctly. To make this less of a chore, create standardized templates for your team to follow. A good system ensures that all required elements of a CCM program are captured consistently, saving time and reducing compliance risks.
CCM billing is all about time. Each CPT code has a minimum time requirement, like the 20 minutes needed for code 99490. The challenge isn't just spending the time, but proving you spent it. Luckily, many activities count—time spent talking with patients or their caregivers, coordinating with other providers, creating or revising care plans, and providing patient education can all be logged. The secret is to track these minutes as they happen, not at the end of the month. Using a platform with a built-in timer or a simple log can make all the difference, turning a major administrative headache into a simple, routine task for your team.
Nothing slows down a workflow like having to enter the same information into two different systems. If your CCM platform and your EHR don't communicate, your team is stuck with redundant data entry, which wastes time and invites errors. For a CCM program to run smoothly, using a certified EHR technology to manage patient data is non-negotiable. When you’re evaluating CCM software or partners, make seamless integration a top priority. A connected system ensures that care plans, time logs, and patient communications are all in one place, creating a single source of truth that makes everyone’s job easier.
Your people power your CCM program, and they need the right tools and training to succeed. Misconceptions about program requirements or a lack of confidence in the workflow can quickly derail your efforts. Invest time in comprehensive training that covers not just the "how" but also the "why" of CCM. When your team understands the program's value to both patients and the practice, they'll be more engaged and effective. Ensure they are comfortable with the technology, documentation standards, and patient communication scripts. A well-trained, confident team is your greatest asset for building a successful and sustainable program.
Building a successful CCM program isn't just about having dedicated staff; it's also about equipping them with the right tools. The technology you choose should support your team, streamline your workflow, and make it easier to provide excellent care—not create more administrative hurdles. Many practices make the mistake of buying software first and then trying to fit their program around it. A better approach is to first define your program's goals and workflow, then find the tools that help you achieve them.
The right combination of technology and software will help you manage everything from patient care plans and time tracking to billing and compliance. Think of these tools as the foundation of your program. A strong foundation allows you to scale your services, maintain high-quality care, and ensure you’re getting reimbursed properly for your work. When your tools work for you, your team can focus less on administrative tasks and more on what truly matters: your patients. A well-equipped CCM program is a sustainable and profitable one.
Before you invest in any platform, map out your ideal CCM workflow. What do you need the technology to do? The best CCM technology should integrate smoothly with your existing EHR, preventing the need for double data entry and keeping all patient information in one place. It should also be user-friendly for both your staff and your patients. Look for a platform that simplifies care plan creation, automates time tracking, and makes it easy to communicate with patients. The goal is to find a solution that fits your practice, not the other way around.
Your billing software is critical to the financial health of your CCM program. If your system can't handle CCM-specific billing requirements, you'll leave revenue on the table. Make sure your software is fully compatible with all relevant CPT codes and can manage the detailed documentation needed for reimbursement. It should accurately track the time spent on non-face-to-face care activities and generate claims that meet payer guidelines. Getting this right from the start saves you major headaches and helps you avoid claim denials, ensuring your practice is compensated for the valuable care you provide.
How do you ensure your CCM program consistently meets all requirements? Quality assurance tools are your answer. These systems help you maintain compliance and deliver high-quality care by monitoring your program's activities. They can flag incomplete documentation, track time requirements for each patient, and ensure every step of the process aligns with Medicare guidelines. This is especially helpful for training new staff and maintaining consistency across your team. By building quality checks into your workflow, you can confidently prepare for any potential audits and prove the value of your services.
A successful CCM program is one that continuously improves. Regularly evaluating your program's performance is essential for long-term success. Use your technology to track key metrics, such as patient enrollment and engagement rates, clinical outcomes, and staff efficiency. Are you meeting your goals? Are your patients healthier and more satisfied? Analyzing this data helps you identify what’s working well and where you have opportunities to grow. This ongoing assessment allows you to refine your processes, improve patient care, and demonstrate the positive impact of your CCM services.
Even the most well-run practices can find CCM billing complicated. Between tracking every billable minute, managing patient consent and care plans, and maintaining audit-ready documentation, it’s easy for critical details to slip through the cracks. That’s why many small and midsize practices turn to a turnkey CCM solution—one that integrates technology, staffing, and billing expertise into a single, compliant system.
A turnkey solution doesn’t just automate documentation; it brings the entire CCM workflow under one roof. That means seamless time tracking, built-in quality assurance, and billing files that meet every Medicare requirement the first time they’re submitted. It also ensures every patient interaction—from medication reconciliation to monthly outreach—is captured and stored in an audit-ready format.
1bios is one example of how this approach works in real life. The platform combines AI-powered automation with an experienced, U.S.-based care coordination team to manage enrollment, documentation, and billing from start to finish. Each CPT-eligible activity is automatically logged, validated, and summarized in a clean report that your billing staff can submit with confidence.
By adopting a purpose-built turnkey CCM solution, practices eliminate the guesswork that often derails CCM programs. The result is fewer administrative errors, faster reimbursement, and a compliance framework you can trust—freeing your team to focus on what really matters: delivering excellent patient care.
Launching a CCM program is a fantastic step toward providing proactive care and creating a new revenue stream. But to make it truly successful, you need to look beyond just the billing codes. A thriving CCM program is built on strong patient relationships, smart technology integration, and a clear focus on results. By optimizing these key areas, you can ensure your program is not only profitable but also makes a meaningful difference in your patients' lives.
A successful CCM program is a partnership. Your patients are more likely to stay engaged when they understand the value and feel supported. Explain that CCM gives them a direct line to care between appointments, including monthly check-ins and help with things like medication management. Set clear expectations from the start and make it easy for them to communicate with your care team. When patients feel heard and actively involved in their health journey, they achieve better outcomes, and your program retains more participants.
Technology should make your life easier, not harder. While the provider billing for CCM services must use a certified EHR, the staff delivering the care has more flexibility. This is where a good partner can be invaluable. The right solution will integrate with your existing systems, simplifying documentation and ensuring all care activities are logged correctly without creating extra work for your team. A smooth workflow means less time spent on administrative tasks and more time focused on patient care, all while maintaining a clear and accurate record for billing and compliance.
How do you know your CCM program is working? By tracking the right metrics. Go beyond just minutes logged and look at clinical outcomes. Monitor things like hospital readmission rates, medication adherence, and patient satisfaction. This data proves the value of your program to both patients and payers. Using tools like Remote Patient Monitoring (RPM) can provide a steady stream of data to help you track progress and make timely interventions. Demonstrating improved health outcomes is the ultimate measure of success and solidifies the long-term value of your services.
Getting paid correctly for your services is critical for a sustainable program. CCM billing can be complex, so it’s important to have a solid process in place. Start by ensuring your team understands the specific requirements for each CPT code. Use a reliable system to meticulously track all time spent on non-face-to-face care coordination. Finally, conduct regular internal audits of your billing to catch any errors and ensure you are capturing all eligible revenue. Proper billing ensures your practice is fairly compensated for the essential care you provide.
It’s much more than just the time spent on the phone with a patient. You can and should count all the non-face-to-face time your clinical staff dedicates to a patient's care. This includes creating and updating their care plan, coordinating with other specialists, managing prescriptions, and communicating with family members or caregivers. The key is to have a simple system for your team to log these activities as they happen so you can accurately bill for the full scope of their work each month.
This is a great question, and the answer is generally no. Medicare has rules in place to prevent paying for overlapping services. For example, you cannot bill for CCM and Transitional Care Management (TCM) for the same patient within the same calendar month. It’s essential to have a process to check for these potential conflicts before you submit your claims to ensure your billing is clean and compliant.
Because CCM is a Medicare Part B service, the standard deductible and 20% coinsurance apply. This means that after Medicare pays its share, your patients may be responsible for a small co-payment. Many patients with supplemental insurance find that this cost is covered. Being upfront about this potential cost-sharing during the consent conversation is an important part of building trust and setting clear expectations with your patients from the start.
If you had to focus on just two things, it would be the patient's consent and their comprehensive care plan. The documented consent is your non-negotiable proof that the patient agreed to the service. The care plan is the living roadmap for their health, detailing their conditions, goals, and treatment plan. Together, these documents form the foundation of a compliant, audit-proof program and demonstrate the thoughtful, personalized care you're providing.
This is the most common concern we hear, and it's completely valid. The most successful CCM programs are structured to protect your team's time. Many practices achieve this by dedicating specific staff members to the program or by partnering with a service that handles the operational heavy lifting. This approach allows you to offer valuable care coordination and generate new revenue without stretching your existing clinical staff too thin.
1bios offers a fully managed CCM solution that includes patient enrollment, care coordination, and end-to-end billing support. Our AI-powered platform auto-documents every interaction, tracks billable time, and generates clean, audit-ready reports for CPT codes like 99490 and 99487. With our onshore staff and built-in compliance tools, providers can confidently grow their program and get reimbursed reliably.