Understanding Chronic Care Management Codes: A Guide for Accurate Billing

Chronic care management (CCM) is essential for patients dealing with multiple chronic conditions. But when it comes to billing and documentation, things can get tricky. That’s where chronic care management codes come in. Understanding these codes helps healthcare providers accurately bill for services and ensure proper documentation.

In this blog, we'll take a deep dive into the key chronic care management CPT codes and how they work in CCM billing.

What Are Chronic Care Management Codes?

Chronic care management codes are part of the Current Procedural Terminology (CPT) system. These codes allow providers to bill for managing patients with chronic diseases—especially those with a significant risk of death or functional decline due to conditions like heart disease, diabetes, or COPD.

The Centers for Medicare & Medicaid Services (CMS) created these codes to support coordinated, ongoing care. CCM services include developing care plans, coordinating among providers, and supporting patient treatment compliance.

Key Chronic Care Management CPT Codes

Let’s explore the primary CPT codes used in CCM billing:

1. CPT Code 99490

• For non-complex CCM
• Covers at least 20 minutes of non-face-to-face care monthly
• Requires a comprehensive care plan and proper CMS documentation

2. CPT Code 99487

• For complex CCM services
• Requires at least 60 minutes of care monthly
• Typically used for patients with higher acuity or more complicated needs

3. CPT Code 99491

• For face-to-face or non-face-to-face time spent directly by a provider
• Requires 30 minutes of direct care monthly
• More intensive than 99490

These codes are often used alongside HCPCS codes and help ensure accurate resource allocation.

Understanding Complex CCM Billing

CPT code 99487 is most commonly used for complex CCM. This billing code is appropriate when:

• A patient has conditions with a significant risk of death
• The treatment plan changes frequently
• Care management time exceeds 60 minutes per month

How CPT Codes Impact Billing & Documentation

Proper use of CPT codes ensures accurate billing and CMS compliance. Each code corresponds to the time spent, care complexity, and whether a face-to-face interaction occurred.

Summary of Common CCM Codes:

| Code | Use Case | | --- | --- | | 99490 | 20+ mins of non-complex CCM; 2+ chronic conditions | | 99487 | 60+ mins for complex conditions; revised or detailed care plans | | 99491 | 30+ mins of provider time (can be face-to-face or virtual) | | 99439 | Add-on for extra 20 mins beyond 99490 | | 99489 | Add-on for extra 30 mins beyond 99487 | | 99437 | Add-on for 30 mins beyond 99491 (for prolonged provider involvement) | | 99495 | Transitional care; face-to-face visit within 14 days post-discharge | | 99496 | Same as above, but more urgent; face-to-face within 7 days | | 99484 | Behavioral health integration (overlaps with CCM for mental health cases) | | 99421 | Digital check-ins (5–10 mins); used for remote chronic condition follow-ups |

Understanding the Physician Fee Schedule

The Physician Fee Schedule (PFS) determines reimbursement rates for each CPT code. To ensure proper payment:

• Submit claims using the correct CPT code
• Match documentation to billed services
• Review the PFS yearly for rate updates

Why Time Tracking Matters

Billing success depends heavily on tracking the time spent on patient care.

Time-tracking tips:

• Document non-face-to-face and face-to-face time
• Log time spent on care plan creation, coordination, and patient outreach
• Keep a clear audit trail in your EHR or RPM platform

When to Use Face-to-Face Codes

CPT 99491 and similar codes are ideal for when:

• Direct in-office evaluation is required
• The patient needs immediate changes to their care plan
• A higher level of provider involvement is necessary

This flexibility is key to delivering hybrid care (in-person + virtual).

Key Takeaways

Mastering chronic care management codes enables accurate billing, better patient care, and smoother reimbursement. Healthcare providers who understand and apply codes like 99490, 99487, and 99491 can:

• Optimize revenue
• Avoid compliance issues
• Improve patient care continuity

With the support of Tellihealth and accuRPM, providers gain tools to streamline tracking, documentation, and billing while delivering concierge, value-based care.

Ready to simplify CCM billing? Tellihealth’s tools are just a click away.
Let us help you optimize revenue and improve outcomes through smarter documentation and code compliance.