Description: Chronic Care management (CCM) focuses on managing a 2 or more chronic condition that puts patients at risk for hospitalization, decline or death. CCM services may be expected to last12-months or until death. 

Delivery Method: Face-to-face, phone or video

Who Can Bill? Physicians, and non-physician practitioners (Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists and Certified Midwives). Clinical staff activities are included under the supervision of the billing practitioner. 
 

Payer
Code    
Billing Allowance  		DescriptionRequirements
Medicare99490
 

20-Mintues of clinical staff time directed by physician or QHP per calendar month 

 

Chronic care management services with  (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored
  • Patient Consent (verbal or written)
    • Must be received at least once and documented.
  • Initiating Visit
    • Conducted once within the past three years.  
    • Medicare AWV may qualify as the initial visit if the provider performed and will be responsible for APCM services.
  • 24/7 Access and Continuity of Care
  • Patient-Centered Comprehensive Care Management Services
  • Patient-Centered Care Plan
  • Management of Coordination of Care (transitions)
  • Enhanced communication opportunities
     
99491First 30-mintues of time spent by billing physician. Clinical staff time does not count toward time threshold   
99437Add on - for each additional 30-minutes of clinical staff time directed by physician or QHP per calendar 
99439Add on - each additional 20 Minutes of clinical staff time directed by physician or QHP per calendar 
9948760-mintues of clinical staff time directed by physician or QHP per calendar month Patients with a two or more conditions with a comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making. 
99489Add on - each additional 30 minutes of clinical staff time directed by physician or QHP per calendar  

*For additional details regarding requirements please reference CMS guidelines*  

MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors. 


CCM Tools

Reference Materials