Chronic Care Management (CCM) services are essential for patients with multiple chronic conditions, ensuring they receive comprehensive care outside of face-to-face visits. CCM also benefits providers, allowing them to provide more efficient care and quicker treatment by enhancing provider-patient communication. Because Medicare wants to prevent unneeded hospitalizations and ER visits, you can be reimbursed for the time spent communicating with patients and their other providers outside of office visits with CCM billing.
How Does CCM Billing Work?
Chronic Care Management billing involves specific codes that healthcare providers use to bill Medicare for the time and resources spent managing patients’ chronic conditions. Whether a patient calls to ask a medical question or you speak with their cardiologist about their care, you can be reimbursed by Medicare for any in-between visit care provided.
Billable CCM services may include:
- Creation and revision of care plans
- Phone calls
- Medication management, such as prescription refills
- Collaboration with other healthcare providers
- Scheduling appointments
- Chart reviews
One of the significant benefits of CCM billing is that it’s not just physicians who get reimbursed for their services. The care provided by nurses on staff is also billable, meaning you can turn non-revenue-generating staff into revenue-generating staff.
Eligibility
Patients must meet several criteria according to the Centers for Medicare and Medicaid Services (CMS) in order to be eligible for CCM. The patient must have two or more chronic conditions that are expected to last 12 months or more. These conditions must also put the patient at significant risk of death, acute exacerbation and/or decompensation, or functional decline.
Billing Code Factors
Different codes are used for reimbursement of different types of CCM. The billing codes used are determined by the following factors:
- Length of time spent providing care: CCM billing codes cover increments of 20, 30, or 60 minutes of care. However, that doesn’t mean you need to spend the exact increment on one service in order to qualify for reimbursement. For example, providing 5 minutes of care at the beginning of the month, plus 10 minutes in the middle of the month, plus 5 minutes at the end of the month all count toward the initial 20 minutes to qualify for CPT code 99490, even if the care is from different staff members.
- Who provided the care: Eligible CCM providers include:
- Physicians
- Physician assistants
- Nurse practitioners
- Certified nurse midwives
- Clinical nurse specialists
- Complexity of care provided: CCM billing codes are divided into standard and complex chronic care management. The amount of time spent providing CCM in a calendar month determines whether the care is considered standard or complex.
How Often Can Chronic Care Management Be Billed?
CCM can be billed on a monthly basis. Each code covers a different increment of time. Standard CCM codes cover increments of 20 minutes, while complex codes cover 60 minutes of care, plus each additional 30 minutes. You cannot bill both standard and complex codes for a single patient in the same month.
There is also a limit to how many times you can bill each code for a single patient each month. This is because Medicare determines it is medically unlikely that you would need to bill more than a certain number of times each month for specific services. This limit is referred to as a Medically Unlikely Edit (MUE).
Breaking Down Different Chronic Care Management Billing Codes
1. Standard “Non-Complex” CCM Billing Codes
CPT 99490:
- Reimburses an average of $61
- Requires a minimum of 20 minutes of non-complex CCM services per calendar month
- Care must be provided by the provider’s clinical staff under the direction of a physician or other qualified healthcare professional
- Can only be billed once per calendar month
CPT 99439:
- Reimburses an average of $47
- Billed alongside CPT 99490 to cover each additional 20 minutes of non-complex CCM services per calendar month
- Care must be provided by the provider’s clinical staff under the direction of a physician or other qualified healthcare professional
- Can only be billed twice per calendar month
2. Physician-Driven, Non-Complex CCM Billing Codes
CPT 99491
- Reimburses an average of $83
- Requires a minimum of 30 minutes of non-complex CCM services per calendar month
- Care must be provided by the billing physician or other qualified healthcare professional
- Can only be billed once per calendar month per patient
CPT 99437
- Reimburses an average of $58
- Billed alongside CPT 99437 to cover each additional 30 minutes of non-complex CCM services per calendar month
- Care must be provided by the billing physician or other qualified healthcare professional
- Can only be billed twice per calendar month per patient
3. Complex CCM Billing Codes
CPT 99487
- Reimburses an average of $131
- Requires a minimum of 60 minutes of complex CCM services per calendar month
- Care must have been directed by a physician or other qualified healthcare professional
- Can only be billed once per calendar month per patient
CPT 99489
- Reimburses an average of $71
- Billed alongside CPT 99487 to cover each additional 30 minutes of complex CCM services per calendar month
- Care must have been directed by a physician or other qualified healthcare professional
- There is no limit on how many times CPT 99489 can be billed per calendar month per patient
Billing CCM with Remote Patient Monitoring
Combining CCM with Remote Patient Monitoring (RPM) can enhance patient care and streamline the billing process. RPM involves using medical devices to collect and transmit patient data to healthcare providers. Billing for CCM and RPM can be done simultaneously for a single patient, provided the services are distinct and documented separately. On average, 40 minutes of CCM and RPM can generate $147 per patient per calendar month.
Streamline Your CCM Billing with ValueCare Suite
Managing a successful Chronic Care Management program can significantly improve patient satisfaction and boost your revenue. However, it can be difficult to keep track of billable CCM services and whether all the criteria have been met each month. Luckily, ValueCare Suite simplifies this process for you. Our intuitive software optimizes your CMS workflows, transforming in-between visit care into billable time. Book a demo today to see how ValueCare Suite can help you succeed.
Images used under creative commons license – commercial use (7/31/2024). Photo by Tima Miroshnichenko on Pexels
