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Chronic Care Management CPT Codes & Billing Guide

Chronic Care Management (CCM) helps patients manage their multiple chronic conditions and offers a valuable recurring revenue stream* for practices that serve CCM patients. The Centers for Medicare and Medicaid Services (CMS) provide reimbursements for these essential services, which include around-the-clock access to healthcare advice, monthly patient consultations, and logistical support for necessities like medication refills and transportation.

However, navigating CCM billing is notoriously complex, involving multiple CPT codes that cover different aspects of CCM care delivery. With a proper understanding of these nuances, you can avoid improper billing and missing out on your practice’s hard-earned recurring revenue stream*.  

In this article, we will break down the most common CPT billing codes used with Chronic Care Management services and their respective definitions and eligibility requirements. We will also explore how using a full-service CCM company can help practices simplify the billing process and maximize reimbursement opportunities.  

*Results may vary by provider. 

Chronic Care Management CPT codes

There are seven CPT codes generally used to bill Chronic Care Management (CCM) services to the Centers for Medicare & Medicaid Services (CMS). These codes are divided into two categories: complex Chronic Care Management services and non-complex (also known as basic or standard) Chronic Care Management services. The five non-complex CCM service CPT codes are the most commonly used CPT codes for  the administration of CCM care. 

• 99490 (Standard 20 Minutes of CCM Services) 
• 99439 (Additional 20 Minutes of CCM Services)
• 99491 (Initial 30 minutes of CCM Care Provided by a Physician or Nurse Practitioner)
• 99437 (Additional 30 minutes of CCM Care Provided by a Physician or Nurse Practitioner)
• G0511 (Care Management Services for RHCs and FQHCs)

CPT code 99490 

Standard 20 Minutes of CCM Services

CPT code 99490 serves as the foundational CPT code for non-complex Chronic Care Management services. CPT code 99490 is used to bill CMS for the first 20 minutes of non-face-to-face CCM services, including telephonic care administered by clinical staff at the direction of a physician or qualified healthcare professional. These twenty minutes can be administered in one session or cumulatively over the course of 30 days. Code 99490 can be billed once per calendar month, every calendar month of the year.

99490 billing requirements

CPT code 99490 requires patients to be diagnosed with two or more chronic conditions to be eligible to receive CCM services. These conditions must be expected to last at least 12 months or until the patient's death. The chronic conditions also must place the patient at risk of acute exacerbation, functional decline, or death. 

Code 99490 also requires creating a comprehensive wellness plan under the direction of a physician. This care plan must be regularly revisited and revised as necessary. Code 99490 is used to bill services specifically addressing the patient’s chronic illnesses. This time should not be spent addressing acute illnesses.

From March 9 to December 31, 2024, the national average reimbursement rate for CPT Code 99490 will be $62.59*. The actual reimbursement amount will vary by region and provider. Check the Physician Fee Schedule for the latest information.

Learn more: Maximizing Your CPT 99490 Reimbursement in 2024

CPT Code 99439

Additional 20 Minutes of CCM Services

CPT code 99439 is used to bill CMS for every additional 20 minutes of non-complex CCM services provided by clinical staff with the supervision of a physician or qualified healthcare professional. Code 99439 is an add-on to CPT code 99490. 

99439 billing requirements

Code 99439 can be billed no more than twice in a given month. Combined with code 99490, providers can bill a maximum of 60 minutes of non-face-to-face, non-complex CCM services to CMS per month. 

The average 2024 reimbursement for CPT code 99439 is approximately  $48*.

CPT Code 99491 

Initial 30 minutes of CCM Care Provided by a Physician or Nurse Practitioner

CPT code 99491 covers the initial 30 minutes of non-complex CCM care personally provided by physicians, nurse practitioners, or qualified health professionals per calendar month. Like code 99490, this code requires patients to be diagnosed with at least two chronic conditions that are projected to last at least 12 months or until the patient’s death. 

99491 billing requirements

The patient’s chronic conditions must place them at significant risk of death, acute exacerbation, or functional decline. The physician or nurse practitioner must establish and implement a comprehensive care plan based on their unique risk factors, conditions, and health history. This plan must be monitored and revised as necessary.   

CPT code 99491 has two primary distinctions from code 99490. CPT code 99491 requires a minimum of 30 minutes of care, and a physician, nurse practitioner, or otherwise qualified health professional must personally administer this care.

The national average 2024 reimbursement for CPT code 99491 is $83.18*.

CPT Code 99437

Additional 30 minutes of CCM Care Provided by a Physician or Nurse Practitioner

CPT code 99437 is billed in tandem with code 99491. Code 99437 covers all additional 30 minutes of CCM care personally provided by physicians, nurse practitioners, or qualified health professionals. 

99437 billing requirements

Code 99437 holds the same eligibility requirements as code 99491. Code 99437 also requires care be administered by a physician, nurse practitioner, or otherwise qualified health professional. CPT code 99437 cannot be billed more than twice in a given month. 

The national average 2024 reimbursement for CPT code 99437 is $58.62*.

CPT Code G0511 

Care Management Services for RHCs and FQHCs

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) both use code G0511 for a wide array of care management services. These include Chronic Care Management, Principal Care Management, Behavioral Health Integration (BHI), Remote Patient Monitoring (RPM), Chronic Pain Management, and more. The criteria for billing CCM services under G0511 are identical to CPT codes 99490 and 99439.  

G0511 billing requirements

As of 2024, RHCs and FQHCs can bill G0511 for multiple instances per month for different care management services if the resources, costs, and time associated with each of the programs are accounted for separately. For example, a single practice could potentially bill G0511 for three services per month: once for CCM services, once for BHI services, and once for RPM services. This also includes billing multiple increments of 20 minutes of CCM services, similar to how code 99439 is used as an add-on to code 99490 for an additional 20 minutes of care provided.

However, while the code’s definition expands to cover multiple instances, this bill can only be submitted once per calendar month. Therefore it is recommended that practices wait until the end of the month to bill code G0511 and ensure they encapsulate all care management services provided.  

From March 9 to December 31, 2024, the national average reimbursement rate for CPT Code G0511 will be $74.20. The actual reimbursement amount will vary by region for FQHCs. RHCs should consistently receive this payment. 

Learn more: How CCM Helps Rural Healthcare Clinics Overcome Challenges.
*The actual reimbursement amount will vary by geographic region and provider. Check the Physician Fee Schedule for the latest information. Results may vary by provider.

Complex Chronic Care Management codes

Two codes are used to bill CMS for complex CCM services–99487 and 99489. Complex CCM services demand a greater investment of clinical service time, more involved care planning and medical decision-making from clinical staff and healthcare providers, and an overall higher degree of involvement from the billing provider. An individual patient cannot be billed using both non-complex and complex CPT codes in the same calendar month. 

• 99487 (60 Minutes of Complex CCM Services)
• 99489 (Additional 30 Minutes of Complex CCM Services)

CPT code 99487 

60 Minutes of Complex CCM Services

CPT code 99487 is used to bill CMS for the first cumulative 60 minutes of non-face-to-face CCM services provided by clinical staff to patients with complex chronic conditions. Medicare introduced this code in 2017 to provide reimbursement for extending care management services to patients whose conditions could not be feasibly addressed in the standard 20-minute allotment covered by code 99490. 

It is important to note the distinction between code 99487 and codes 99491 and 99437. Code 99487 is used for 60 minutes of non-face-to-face, complex CCM services provided by non-physician practitioners and clinical staff. Codes 99491 and 99437 are used for a combined total of 60 minutes of in-person, non-complex CCM care provided by physicians. These codes cannot be billed together in the same calendar month. 

99487 billing requirements

The eligibility requirements to bill code 99487 are the same as 99490. The patient must be diagnosed with two or more chronic conditions expected to last a minimum of 12 months or until the death of the patient. These conditions must be at an acute risk of exacerbation, placing the patient at risk of death or functional decline. An individualized wellness plan must be established with the patient and regularly monitored and adjusted throughout the patient’s healthcare journey. 

The national average 2024 reimbursement for CPT code 99487 was $131.97*.  

CPT code 99489 

Additional 30 Minutes of Complex CCM Services

CPT code 99489 is an add-on to code 99487. CPT code 99489 covers any additional 30 minutes of care devoted to non-face-to-face, complex CCM services provided by clinical staff. Code 99487 is used to bill for the initial 60 minutes of care provided per calendar month. All subsequent complex CCM services provided should be billed using code 99489. 

99489 billing requirements

CPT code 99489  carries the same eligibility requirements as code 99487. There is no limit on how many times a provider can bill code 99489 in a single month. Complex CCM service codes were introduced with the understanding that some patients require multiple hours of chronic care services every month.  

The national average 2024 reimbursement for CPT code 99489 was $71.06*.

*The actual reimbursement amount will vary by region and provider. Check the Physician Fee Schedule for the latest information. Results may vary by provider.

What chronic care management services are eligible for reimbursement?

Most CPT codes associated with Chronic Care Management services reimburse healthcare practices for non-face-to-face care through clinical staff or otherwise qualified health professionals. These codes include 99490, 99439, and G0511. This care can be conducted in a variety of ways, including over the phone, through texting, using telehealth platforms, or even through mail and email. . 

Chronic Care Management was created to actively engage patients with chronic conditions in their health journey between clinical appointments. CCM provides a monthly cadence of communication between patients and care managers, facilitating conversations about new and worsening symptoms, the closure of gaps in care, and  Social Determinants of Health (SDOHs) that may interfere with a patient’s ability to access care. These conversations and the services associated with them are all reimbursable through Medicare. 

Billable CCM services may include: 

• 20 minutes of monthly care via phone, texting, email, or telehealth platforms, including care planning
• Discussing a patient’s individual health goals, personal and familial health history, and lifestyles and behaviors  
• Assisting patients in scheduling appointments and medical services
• Reviewing the wellness plan established by the patient’s physician
• Aiding in the refill and delivery of prescription medications
• Communicating about new, developing, or worsening symptoms
• Coordinating between practices, hospitals, and specialists to provide patients access to charts, labwork, and test results 
• Providing self-management tips and ongoing education about a patient’s illnesses
• Identifying gaps in care, helping the patient close them, and engaging in preventive care
• Arranging transportation to and from appointments
• Connecting patients to local community resources, including senior activity and exercise groups, food banks, and financial assistance 

To bill CMS for CCM services, providers must attain the patient’s consent to enroll in the program and receive CCM services. They must document and archive this consent appropriately. All patients enrolled in Chronic Care Management must have a comprehensive care plan created by or under the supervision of a provider to be eligible for reimbursement. 

Learn more: Chronic Care Management: A Guide for Providers

Chronic Care Management billing guidelines

To submit a CCM reimbursement claim to CMS, your practice will need five pieces of information and documentation.

What you need to submit CCM claims to CMS:

1. The CPT codes that apply to the services rendered to the patient
2. The location or method by which the services were provided. This is most commonly over the phone, via a telehealth platform, or in person at your practice 
3. The date(s) of service on which the CCM services were administered
4. The ICD-10 codes associated with each of the conditions your CCM program is helping the patient manage 
5. The National Provider Identifier (NPI) number 

It’s also wise to keep a record of the care manager(s) assigned to each patient. While CMS does not require this information for straightforward CPT billing, this information will be helpful in case of an audit or complications. 

How to submit your bill for CCM services to CCM:

1. Verify that the patient is eligible, consenting, and enrolled in your Chronic Care Management program. 
2. Check that the appropriate services were provided for the patient that month. In most cases, this will be a minimum of 20 minutes of telephonic CCM service provided by a member of your or your CCM partner’s clinical staff. 
3. Submit the claims to CMS for approval.
4. Invoice the patients the copay and any other charges for their monthly CCM services.
5. Ensure that there is no conflict or duplication in the codes that are billed to Medicare.  

Who can provide CCM services?

CCM services can be provided by: 

• Physicians
• Physician’s Assistants (PAs)
• Certified Medical Assistants (CMAs)
• Registered Nurses (RNs)
• Licensed Professional Nurses (LPNs/LVNs)
• Certified Nurse Midwives
• Pharmacists
• Care Managers
• Clinical Staff under the general supervision of an overseeing provider

Though most CCM CPT codes are intended for nonphysician time, CMS understands that sometimes physicians do provide CCM services during their administration of care. However, CCM was created to incorporate a regular cadence of care management services into the lives of chronically ill patients without requiring them to see their primary care provider or a specialist. CCM services should be provided by clinical staff members focused solely on administering CCM care if a practice seeks to receive the greatest benefits from their program.  

How does CMS define clinical staff?

According to CMS, a clinical staff member is defined as personnel working under the supervision of a physician or qualified healthcare professional. They must be allowed by law, regulation, and practice policy to administer Chronic Care Management services or assist in the administration of such services. However, clinical staff members do not individually report that professional service. 

Clinical staff can be employed by a third-party service, like a Chronic Care Management partner, as long as the billing practitioner maintains functional oversight over the care management program. CMS further specifies that this means that the overseeing provider only needs to be available to the company via telephone. These companies cannot bill CMS for the CPT codes, though they can assist in the documentation, preparation, and review of the bills. The billing practitioner must ultimately be the one to submit the final bill to CMS for reimbursement.  

Learn more: CCM Compliance: Answering Frequently Asked Questions.

Seamlessly implement CCM services with ChartSpan

ChartSpan is an innovative, industry-leading Chronic Care Management company. We proudly provide healthcare providers with fully managed CCM programs that elevate the quality of care administered to your patients. 

Implementing an in-house CCM program demands an exhausting amount of resources, time, and energy. Many providers are too overwhelmed by the prospect to undertake the enterprise, and many who try to do so unaided abandon the program altogether. However, ChartSpan eliminates the daunting workload with our turnkey program. 

Our team of trained clinical professionals handle patient outreach, educating eligible patients on the benefits of CCM, obtaining their consent, and enrolling them in the program. Our care managers then call enrolled patients every month, supplying them with the CMS-required 20 minutes of CCM care. From transportation arrangements to medication refills to self-management advice, our team is equipped to help your patients navigate the difficulties of chronic illnesses. 

Simplify CPT billing with ChartSpan’s RapidBill technology

ChartSpan’s RapidBill technology allows your practice to review and bill with ease every month. Our proprietary service eliminates the stress of manual billing, ensuring providers and their staff only need to review the bills before submitting them. 

We will assemble the required documentation, identify the correct CPT codes, and submit it to your practice for review. After you approve it, the only work required on your practice’s end is to submit the bill to CMS. Our customer success team can also assist with billing-related questions and any denials if necessary. ChartSpan’s RapidBill simplifies billing, smoothly integrating a recurring revenue stream* into your practice. 

Adding a CCM solution to your care management services addresses care gaps, increases your quality scores and CMS reimbursements*, and improves patient outcomes. Contact us to learn more about how ChartSpan’s CCM services can transform your practice’s workflow and your patients’ lives. 

*Results may vary by provider.

You may also like:

• A Healthcare Provider’s Guide to Value-Based Care 
• 9 Ways to Increase Patient Retention with CCM
• The Challenges of Managing Patients with Multiple Chronic Conditions