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:

1. 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. 
2. Who provided the care: Eligible CCM providers include:
   • Physicians
   • Physician assistants
   • Nurse practitioners
   • Certified nurse midwives
   • Clinical nurse specialists
3. 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

The post An Overview of Chronic Care Management Billing in 2024 appeared first on ValueCare Suite.

What Is Chronic Care Management?

Chronic Care Management (CCM) is a Medicare Part B program that allows healthcare providers to bill Medicare for the time and resources spent managing a patient’s chronic condition. It covers all the services a patient’s primary care team provides in between visits, such as developing a care plan, recording patient health information, managing their medications, and coordinating care between providers. 

At least 20 minutes or more of CCM services can be billed per month. However, the patient must have two or more chronic conditions in order for the primary care team to be eligible for reimbursement.  

Why Is CCM Important?

The Chronic Care Management program is designed to improve the quality of life for both patients and practitioners. 

• Patients receive access to important medical resources, more efficient communication with their primary care team, and ongoing support that allows the patients to be more engaged in their own care. 
• Practitioners can be reimbursed for the care provided in-between office visits known as “in-between visit care”. Both the practitioner’s time and their clinical staff time spent on these services are now billable through CCM. These are services already provided but typically not considered billable, such as managing patient medications, reviewing and explaining test results, coordinating care between providers, answering patient questions, and offering health education.
• CCM improves patient-practitioner relationships, which increases patient satisfaction and compliance, and also increases revenue for the healthcare provider.

Key Takeaway: Transform Non-Revenue Tasks into Profit with CCM

In a physician’s office, the main revenue comes from the physician’s work. To increase revenue, you need more physicians and more office visits. One huge benefit of running Chronic Care Management (CCM) is that it turns non-revenue-generating tasks and staff into revenue-generating ones. With CCM services, an employee earning $20-$35 per hour can generate over $120 per hour for the office.

Which Conditions Qualify for Chronic Care Management?

As we mentioned earlier, eligible CCM patients must have two or more chronic conditions. According to the Centers for Medicare and Medicaid Services (CMS), chronic conditions must be expected to last at least one year, or until the patient’s death. Conditions that put the patient “at significant risk of death, acute exacerbation and/or decompensation, or functional decline” also qualify. 

Eligible chronic conditions include, but are not limited to:

• Alzheimer’s disease
• Arthritis
• Asthma
• Autism spectrum disorders
• Cancer
• Cardiovascular disease
• Chronic Obstructive Pulmonary Disease (COPD)
• Depression
• Diabetes
• Glaucoma
• Hypertension
• HIV/AIDS
• Osteoporosis

How Does Billing for CCM Work?

One of the biggest questions practitioners have about Chronic Care Management is how to bill for it. Billing for CCM involves using specific codes to ensure proper reimbursement. Practitioners may submit their claim at the end of the service period (one calendar month), or after completing the minimum required billable time. 

ValueCare Suite software solution takes the guesswork out of structuring your billing codes. Your team documents each care performed, and we categorize the codes and generate a billing report accordingly.

Basic “Non-Complex” CCM Codes

Practitioners can bill for basic CCM using the following codes: (CPT codes 99490 and 99439 are the most common and frequently used in Chronic Care Management (CCM).)

• CPT 99490: A minimum of 20 minutes of non-complex CCM services provided by the provider’s clinical staff under the direction of a physician or other qualified healthcare professional. The maximum billable amount per month is 1 unit.
• CPT 99439: This add-on code is used alongside CPT 99490 for each additional 20 minutes of non-complex CCM services provided by the provider’s clinical staff under the direction of a physician or other qualified healthcare professional. It is billed after the requirements for CPT 99490 have been met. The maximum billable amount per month is 2 units.
• CPT 99491: A minimum of 30 minutes of non-complex CCM services provided personally by the billing physician or other qualified healthcare professional per calendar month. The maximum billable amount per month is 1 unit.
• CPT 99437: This add-on code is used alongside CPT 99491 for each additional 30 minutes of CCM services provided by a physician or other qualified healthcare professional. It is billed after the requirements for CPT 99491 have been met. The maximum billable amount per month is 2 units.

Complex CCM Codes

Billing for complex Chronic Care Management involves the following codes: 

• CPT 99487: This code is used for complex CCM services totaling at least 60 minutes of clinical staff time per calendar month, that were directed by a physician or other qualified healthcare professional.
• CPT 99489: This add-on code is used with CPT 99487 for each additional 30 minutes of complex CCM services provided by clinical staff per calendar month, under the direction of a physician or other qualified healthcare professional. It is billed after the requirements for CPT 99487 have been met. This code covers each additional 30 minutes of complex CCM services provided per calendar month.

While physicians, physician assistants, nurse practitioners, certified nurse midwives, and clinical nurse specialists can all bill for CCM, only one practitioner can receive reimbursement per patient each calendar month. The practitioner can report either non-complex or complex CCM services for each patient per calendar month, but not both. 

As of 2024, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill for CCM using code HCPCS G0511 as well as Transitional Care Management (TCM) services for a single patient in the same calendar month. 

Grow an Effective CCM Program with ValueCare Suite

An effective Chronic Care Management program will lead to better patient satisfaction and higher revenue for their healthcare provider. But keeping track of billable CCM services can be challenging. At ValueCare Suite, we take the guesswork out of implementing successful CCM programs. Our user-friendly software streamlines your CMS workflows and helps you turn activities like phone calls with patients and physician collaboration into billable time. Book a demo today to learn more. 

Images used under creative commons license – commercial use (5/20/2024). Image by freepik

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