What is chronic care management?

Chronic Care Management (CCM) is defined by the Centers for Medicare and Medicaid Services (CMS) as coordinating care for patients with multiple chronic conditions outside regular office visits. These conditions are expected to last at least 12 months or until the patient passes away.

What are the benefits of chronic care management?

CCM helps practices create personalized care plans, improve adherence to care guidelines, streamline documentation, and support a more efficient billing workflow. The goal is to improve outcomes, reduce complications, and stay aligned with CMS requirements.

How does chronic care management work?

CCM typically includes patient enrollment, creation of a care plan, ongoing monthly care coordination and patient communication, and accurate documentation for billing and reimbursement.

What services are included in chronic care management?

CCM services can include identifying chronic conditions, developing care plans, coordinating referrals, reviewing results, medication support, documenting monthly communication time, and recording billable actions for compliance.

What are Chronic Care Management CPT codes?

CCM CPT codes are billing codes used to report chronic care management services. Common codes can include 99490, 99439, 99487, 99489, 99491, and related codes, depending on the service level and time.

How do Chronic Care Management CPT codes work?

Practices use CCM codes to bill for specific care coordination services based on eligibility, documented activities, and time thresholds. Proper documentation supports accurate reimbursement and transparency for the care delivered.

Remote Patient Monitoring

CPT	DESCRIPTION	NATIONAL AVERAGE
99453	Device Setup	$21.71
99445	2-15 Days of Device Readings	$52.11
99454	16+ Days of Device Readings	$52.11
99470	RPM Care Team 10-19 Mins	$26.05
99457	RPM Care Team First 20 Mins	$51.77
99458	RPM Care Team Ea Addtl 20 Mins	$41.42

Remote Therapeutic Monitoring

CPT	DESCRIPTION	NATIONAL AVERAGE
98975	Initial Setup	$21.71
98976	16+ Days of Respiratory Device Readings	$52.11
98980	RTM Care Team First 20 Mins	$54.11
98981	RTM Care Team Ea Addtl 20 Mins	$41.42

Chronic Care Management

CPT	DESCRIPTION	NATIONAL AVERAGE
99490	CCM Care Team First 20 Mins	$66.13
99439	CCM Care Team Addtl 20 Mins	$50.44
99487	Complex CCM First 60 Mins	$144.29
99489	Complex CCM Ea Addtl 30 Mins	$78.16

Advanced Primary Care Management

CPT	DESCRIPTION	NATIONAL AVERAGE
G0556	APCM Level 1	$16.37
G0557	APCM Level 2	$53.78
G0558	APCM Level 3 *Medicare primary+Medicaid Secondary	$117.24

Behavioral Health Integration

CPT	DESCRIPTION	NATIONAL AVERAGE
99484	Behavioral Health Integration	$51.77

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Remote Patient Monitoring

Remote Therapeutic Monitoring

Chronic Care Management

Advanced Primary Care Management

Behavioral Health Integration

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