Originally published January 29, 2018. CMS has added CCM codes since 2018 (including 99439 and principal care management codes). Payer rules change; confirm current CMS and payer requirements before billing.
Chronic care management (CCM) is usually provided outside face-to-face visits. The CCM service period is one calendar month. Once the 20-minute threshold is met, the practitioner can use that date as the date of service and doesn't need to hold the claim until the end of the month.
- 99490
- Chronic care management, at least 20 minutes
- 99487
- Complex chronic care management
- 99489
- Complex CCM, each additional 30 minutes of clinical staff time
Key CCM requirements
- Two or more chronic conditions expected to last at least 12 months, or until the patient's death
- Patient consent before providing or billing CCM. Consent can be verbal or written, but must be documented in the medical record
- A comprehensive care plan is established or substantially revised
- 24/7 access to physicians, other qualified professionals or clinical staff
Examples of chronic conditions
- Alzheimer's disease and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer (breast, colorectal, lung and prostate)
- Cardiovascular disease
- Chronic kidney disease
- COPD
- Depression
- Diabetes
- Heart failure
- Chronic viral hepatitis B and C
- HIV/AIDS
- Hyperlipidemia
- Hypertension
- Ischemic heart disease
- Osteoporosis
- Schizophrenia and other psychotic disorders
- Stroke
CMS resources: CCM billing FAQs and CCM services booklet.