What is chronic care management? And how do you bill for CCM?

What is chronic care management? And how do you bill for CCM?

Chronic Care Management (CCM) is defined as the care for patients with chronic diseases and health conditions such as diabetes, high blood pressure, lupus, multiple sclerosis, sleep apnea and other life-long health problems. Since 2015, such care provided as a non-face-to-face service to patients with two or more chronic conditions are reimbursable. Such CCM eligible tasks include making a care plan, monitoring and analyzing patient data, coordinating and sharing patient information with other health departments and all communications with the patient outside the doctor’s office.


What patients qualify for chronic care?

Patients with two or more chronic conditions qualify for such a reimbursable care under relevant CPT codes. The patient must be at risk of either a) death, b) worsening of conditions, c) organ failure or 4) functional decline. And their chronic conditions must be expected to last at least 12 months or until their death.

How to bill for Chronic Care Management?

From January 1, 2015, a doctor can claim reimbursement for non-face-to-face care through several CPT codes. The first applicable code was the CPT 99490 (non-complex care) that pays $43 per patient per month for a minimum of 20 mins of care by clinical staff or a physician or other qualified healthcare professionals. Since 2015, when CMS first introduced the opportunity for doctors to bill for CCM under the CPT 99490 code, several other codes have been added, with many of them relating specifically to remote patient monitoring (RPM) services. The first RPM dedicated code was CPT code 99091, introduced in January 2018, which pays $57 a month per patient to doctors or qualified healthcare professionals who meet the 30 minute minimum requirement. This code has made remote patient care more attractive as it can be billed concurrently with the basic CPT 99490 code, benefiting practitioners for their extra time when handling more time demanding patient cases. In January 2019 three more remote patient monitoring related codes were added: these include CPT codes 99487, 99489 and 99091.  

What is needed to start billing for Chronic Care Management?

Billing for CCM codes is easy. Doctors interested in implementing and billing for CCM need to obtain the patient’s verbal consent and document it in their EHR system or CCM platform and they also need to track the time they spend each month on performing such care. You can do so on a simple spreadsheet or use a dedicated tool that would make it easier. Each month a doctor can then bill for all patients where the minimum time requirement was met.

Code CPT 99490 is subject to cost-sharing. This includes the patient’s deductible, co-pay and co-insurance, which needs to be collected from the patient as you would normally do.

Your medical billing service provider submits your CCM claims the same way they would do with any other reimbursement claims but the benefit of billing for CCM codes is that these can be billed monthly for as long as your patients stay engaged in the program and you meet the monthly billing requirements.

Ready to earn reimbursement for remote patient monitoring services? Qardio’s RPM platform, QardioMD, has a built-in billing feature, which automatically tracks the time physicians spend on each patient, to improve efficiency and to reduce unnecessary audit errors. Book a demo to see how QardioMD works »