At vitalera, we understand how Chronic Care Management (CCM) plays a crucial role in helping patients manage multiple chronic conditions while providing a valuable recurring revenue stream for practices. The Centers for Medicare and Medicaid Services (CMS) reimburse for these essential services, including 24/7 access to healthcare support, monthly patient consultations, and logistical assistance with medication refills and transportation.

However, navigating the complexities of CCM billing can be challenging, with various CPT codes covering different aspects of care. Having a clear understanding of these codes is key to avoiding billing mistakes and ensuring your practice captures the full potential of its revenue.

In this article, we will outline the most common CPT codes used in Chronic Care Management, explaining their definitions and eligibility requirements. Additionally, we will highlight how partnering with vitalera can help streamline the billing process and optimize your practice’s reimbursement opportunities.

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What is Chronic Care Management (CCM)?

Chronic care management (CCM) offers personalized support to help patients improve their health and quality of life. By working closely with their healthcare provider, they can reduce the risk of health complications, hospitalizations, and falls.

CCM provides comprehensive care plans tailored to every patient's specific needs, along with frequent communication, resources, and educational support. This approach empowers the patients to take an active role in managing their chronic conditions and achieving their desired health goals. CMS.gov

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What is the value of CCM for clinics or healthcare systems?

Chronic Care Management (CCM) is a specialized healthcare service designed to support individuals with multiple chronic conditions. By providing coordinated care and ongoing support, CCM helps patients manage their health more effectively.

Services Offered: CCM services typically include:

• Regular check-ins: At least 20 minutes of care coordination per month through phone calls, video consultations, or secure messaging.
• Personalized care plans: A dedicated healthcare professional works with the patient individually to develop a personalized care plan that aligns with the patient goals.
• Care coordination: Assistance with scheduling appointments, coordinating medications, and navigating the healthcare system.
• 24/7 access: Emergency access to a qualified healthcare professional and support with setting and achieving health goals.

Benefits of CCM: By participating in CCM, patients can expect improved health outcomes, and enhanced quality of life, and healthcare providers benefit from reduced healthcare costs.

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4 Things You What to Know About CCM  Reimbursement?

Chronic Care Management (CCM) provides a systematic framework for managing patients with multiple chronic conditions by focusing on coordinated care. It emphasizes services such as patient education, and comprehensive care coordination. This approach improves patient health outcomes, enhances their quality of life, and helps lower overall healthcare costs by reducing the need for more intensive, emergency care

To ensure effective CCM implementation, healthcare providers must navigate specific criteria:

1) Eligibility: Patients must meet specific requirements, often including having two or more chronic conditions and being enrolled in Medicare or Medicaid.

To qualify for CCM, patients must:

• Have two or more chronic conditions lasting at least 12 months.
• Be at significant risk of complications, exacerbations, or functional decline.

Eligible Conditions: Heart disease, diabetes, hypertension, asthma, cancer, arthritis, depression, dementia, and more.

Providers: Primary care physicians, specialists, nurse practitioners, and physician assistants.

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2) Documentation: Clear documentation of patient interactions, care plans, and progress is crucial.

• Patient Consent: Obtain written or verbal consent, documenting it in the EHR.
• Comprehensive Care Plan: Outline medical, functional, and psychosocial needs, patient goals, and care team members.
• Communication and Coordination: Log time spent on care coordination and communication.
• Non-Face-to-Face Services: Document at least 20 minutes per month of non-face-to-face care management.
• Billing and Timekeeping: Accurately track time spent on CCM services

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3)Technology: Secure platforms for communication and data management are essential. And below requirements are important:

• EHR: Use a certified EHR to document CCM services.
• 24/7 Access: Ensure patients can access care and communicate outside of office hours.
• HIPAA Compliance: Use secure, HIPAA-compliant methods for communication.
• Interoperability: Enable information sharing with other providers.

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4)Costs: Understanding reimbursement models and associated costs helps make CCM a viable option.

Patient Costs:

• Medicare Copayment: Patients may be responsible for 20% of costs.
• Medigap or Secondary Insurance: May cover additional costs.

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Providers Reimbursement: CPT billing codes for CCM:

Chronic Care Management (CCM) services are reimbursed under specific CPT codes that cover the coordination of care for patients with multiple chronic conditions. Here are the key CPT codes for Chronic Care Management:

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1. CPT 99490: This code covers at least 20 minutes of clinical staff time spent on non-face-to-face care coordination services for patients with two or more chronic conditions.

Reimbursement: Typically covers basic CCM services that are provided once per calendar month.

2. CPT 99439: This is an add-on code for each additional 20 minutes of care management services provided beyond the initial time covered by CPT 99490.

Reimbursement: Used when more than 20 minutes but less than 40 minutes of CCM is provided in a month.

3. CPT 99491: This code is for at least 30 minutes of direct physician or qualified healthcare professional time spent on CCM services per month. 

Reimbursement: This is billed when a physician or healthcare professional provides the care themselves, not the clinical staff.

4. CPT 99437 : This add-on code covers each additional 30 minutes of care management provided by the physician or qualified healthcare professional, billed alongside 99491.

Reimbursement: This can be used when more extensive CCM services are needed.

5. CPT 99487: This code is for complex CCM services, covering 60 minutes of clinical staff time spent on care management for patients with more complex conditions.

Reimbursement: Used when the patient requires more comprehensive care coordination.

6. CPT 99489: This is an add-on code for each additional 30 minutes of complex CCM services provided in the same month, beyond the initial 60 minutes covered by 99487.

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vitalera: empowering Chronic Care Management for CPT Reimbursement:

 Our platform seamlessly integrates with Electronic Health Records (EHRs) and provides a fully compliant, HIPAA-secure system that supports 24/7 access to care and real-time monitoring, we are your partners in connected healthcare.

With vitalera, healthcare providers can:

• Automate Care Coordination: Our system ensures that all aspects of patient care are efficiently managed. This allows providers to focus on what matters most which is improving patient outcomes.
• Maximize Reimbursement: We ensure that all CCM billing codes such as CPT 99490 and 99491 are utilized effectively. Our platform helps providers log the necessary time, maintain thorough documentation, and ensure compliance with Medicare guidelines, making it easy to receive proper reimbursement.
• Interoperable with Existing Systems: vitalera is built to integrate smoothly with your existing EHR and practice management systems, reducing the learning curve and increasing efficiency.

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By using Vitalera’s solution, healthcare providers can deliver high-quality care while ensuring they maximize their revenue through efficient, compliant billing processes.

To know more about our solution. Contact Us

‍References: HHS/CMS. (n.d.). WHAT IS CHRONIC CARE MANAGEMENT?