Chronic Care Management CPT Codes & Guidelines
- Author : Mark Twain
- Date : 21/12/2025
Chronic care practices have to deal with different types of chronic conditions that are time-bound in nature. Patients with chronic conditions usually need prolonged healthcare management by providers. It includes monthly or annual checkups, follow-ups, monitoring, and logistical support.
However, there is a problem with that. These practices also require rigorous billing practices because of the complex nature of chronic care management. Multiple other factors add to the gravity of the situation. These factors include increasing patient volume, growing regulations, and the multiplicity of conditions.
In this article, we will talk about Chronic Care Management billing and CPT codes. We will see how these codes affect the revenue management of the chronic care practices. So let’s see how CCM works and what part these CPT codes play in the process.
What Is Chronic Care Management?
Chronic Care Management is the process of providing medical services to patients with more than one chronic condition. These conditions are usually expected to last for a year or until death. Chronic care management deals with managing medications, treatment plans, care, and patient engagement.
Chronic care management is also a non-face-to-face type of service, which means that patients are usually not hospitalized. The services are provided in a repetitive way with occasional checkups and treatments. Therefore, the reimbursements are also repetitive and complex, just like the CCM itself.
What Are CCM CPT Codes?
Chronic Care Management (CCM) codes are a set of billing codes that are used to refer to the exact services provided, so you can get paid for them. Just like every other specialty, chronic care practices also have their own codes used for the services they provide. These codes are created by CMS and are standardized. They not only show services but also the time and effort required.
These CCM CPT codes vary for different types of services. For a simple 20-minute care, the codes will be different than those for a complex, extensive, and chronic care. Their proper and appropriate use is critical in ensuring that you get paid for the exact services you provided. Any under- or over-codes can lead you to either underpayment or claim denial.
Common Chronic Care Management CPT Codes
It is important to understand some of the common chronic care management CPT codes so that our claims are successful and the reimbursements are done promptly. Here are some of the common codes:
CPT 99490 (Basic Chronic Care Management)
CPT 99490 covers at least 20 minutes of clinical staff time per month that is spent on indirect care coordination. This care is provided to patients usually struggling with more than one chronic condition at a time. You need to have a certified EHR and the patient plan in order to get your reimbursements.
CPT 99439 (Add-On Code for Additional Time)
It is not necessary that the care can be completed within the first 20 minutes. Therefore, 99439 is the code that you use for every extra 20 minutes of CCM beyond the first session covered by 99490. CPT 99439 must follow the 99490 as it can not stand alone.
CPT 99487 (Complex CCM)
This code is a higher-level medical code that is used for patients who require at least one hour of clinical staff time. This refers to moderate to high CCM and includes managing unstable conditions or administering medications that need to be monitored.
CPT 99489 (Add-On Code for Complex CCM)
Just like the 99439, 99489 is also a code that is used as an add-on code after the first period. It is used with 99487 for every additional half hour spent on complex CCM. The nature of these medical activities is critical, and they involve a higher risk and increased involvement of the staff.
What Services Count Toward CCM Time?
Chronic Care Management is not an ordinary healthcare specialty. Therefore, not all activities qualify for CCM billing. Here are some of the tasks that are allowed as billable time.
- Creating or updating care plans
- Medication reconciliation
- Reviewing test results or specialist notes
- Coordinating care with pharmacies and specialists
- Communicating with patients via phone or portal
- Monitoring patient progress or symptoms
- Educating patients on lifestyle changes
Best Practices for CCM Billing
Once we have talked about chronic care management and the CPT codes associated with it, let’s talk about the best practices for CCM billing. These practices are necessary for reimbursements without delays.
Track Time Accurately
Time tracking is important for CCM billing, and that too should be real-time. Some billers estimate time at the end of each month, which can lead to inaccuracies and over-reporting. The best practice is to use digital timers and other tools in your EHR. They help you record the time you’ve spent on patient care so that you can get your revenue on time.
Use CCM-Supported Technology
EHR systems that are equipped with built-in CCM tracking modules are better able to improve your compliance status. These tools help you automate time logging, keep documentation organized, and store plans. They help you meet requirements presented by healthcare insurance providers.
Training on Eligible Activities
Proper billing requires your team to know which activities are qualified as CCM. Doctors should train clinical staff on billable and non-billable tasks, such as care planning, patient check-ins, medication reviews, and coordination with specialists. This initiative avoids errors and helps maximize reimbursable time.
Maintain Monthly Reporting
Another thing that is important in medical billing CCM is to maintain monthly or annual records and reporting. These reports help verify that the minutes recorded match the performed activities. They also support clean claims submission and allow practices to identify gaps early in the process.
Know Your Insurance’s Rules
There might be different requirements from commercial payers and Medicare Advantage apart from standard CCM frameworks. They may vary in aspects like coverage, supervision rules, and others. Therefore, it is critical to review payer-specific guidelines to ensure your practice is compliant and you don’t get denials.
Also read this: Remote Patient Monitoring CPT Codes and Guidelines
Start Delivering Better Care With Accurate CCM Billing
Conclusion
Chronic Care Management is an essential part of modern healthcare. With evolving time, more and more patients are getting more than one long-term health condition. These conditions require ongoing support by healthcare professionals and chronic care management practices.
Chronic Care Management Billing and CPT Codes are complex because billers need to handle more than one condition at a time. This often leads to errors and mistakes. Accuracy in CCM billing ensures your revenue cycle keeps on going without any setbacks.
When the flux of patients with more than one chronic disease increases, those practices that have dedicated structured CCM billing services can perform well. A dedicated CCM medical biller can take your specialized billing to new heights with accuracy and efficiency.
Frequently Asked Questions
A patient qualifies for CCM if they have two or more chronic conditions expected to last at least 12 months or until death. These conditions must place the patient at significant risk of functional decline, hospitalization, or poor outcomes.
Yes, Medicare requires verbal or written consent before enrolling a patient into a CCM program. Consent must be documented in the patient’s medical record and include details about services, cost-sharing, and the option to discontinue at any time.
CPT 99490 requires at least 20 minutes of non-face-to-face clinical staff time per calendar month. This time must involve care coordination, medication management, patient communication, or other eligible CCM activities.
No. Medicare does not allow billing for Chronic Care Management and Transitional Care Management (TCM) for the same patient within the same month. Providers must choose the most appropriate service based on the patient’s needs.
Clinical staff under the general supervision of a billing provider can perform CCM activities. It depends on payer rules. Physicians, nurse practitioners, physician assistants, and other qualified healthcare professionals can oversee and bill for CCM.
CCM was created for Medicare beneficiaries. However, many Medicare Advantage and commercial insurance plans also offer coverage. Coverage details may vary, so providers must check payer-specific guidelines.
