Billing for CPT 99490 and related codes requires knowledge of the CMS Chronic Care Management (CCM) program as a whole, as well as an understanding of how the program is structured for billing purposes. Read on to learn the ins and outs of billing for CPT 99490.
What is Chronic Care Management?
Chronic Care Management refers to care coordination provided outside of the regular office visit for patients with multiple chronic conditions. Since 2015, Medicare has offered monthly reimbursements for these services. Non-complex CCM services, billed under CPT 99490, include at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, and encompass the following elements:
- Use of Certified EHR Technology (required for billing CCM codes, but no longer mandatory for CCM documentation or transitional care management documents)
- 24/7 Access & Continuity of Care
- Comprehensive Care Management
- Comprehensive Care Plan
- Management of Care Transitions
- Home- and Community-Based Care Coordination
- Enhanced Communication Opportunities
An initial visit is required for new patients or those who have not been seen in the past year. This can be an Annual Wellness Visit, Initial Preventive Physical Exam, or another face-to-face visit with the billing practitioner. Such a visit is billed separately from CCM services. Additionally, billing practitioners must obtain patient consent before providing or billing for CCM services.
Complex CCM services, billed under CPT 99487, include a substantial revision of a care plan, moderate or high complexity medical decision-making, and at least 60 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month.
For the most recent CMS CCM guidelines, visit the CMS website.
Who Needs CCM?
CCM is intended for patients with multiple chronic conditions expected to last more than a year or throughout their lifetime and that place them at significant risk of death, acute exacerbation/decompensation, or functional decline. A non-exhaustive list of chronic conditions can be found in the CMS Chronic Conditions Data Warehouse.
The goal of CCM programs is to improve care and outcomes for these patients. Comprehensive care management for chronic conditions enhances the individual’s quality of life, reduces financial burdens, and improves overall health. Providers and payers also benefit from improving long-term patient health outcomes.
Eligible Practitioners for Billing CPT 99490
Several types of practitioners may bill for CCM, including:
- Physicians
- Non-Physicians:
- Physician Assistants
- Nurse Practitioners
- Certified Nurse Midwives
- Clinical Nurse Specialists
- Other clinical staff may provide CCM services under the general supervision of an eligible practitioner.
Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Critical Access Hospitals (CAHs) can also bill for CCM services. If two practitioners in the same practice provide CCM for a patient, only one may bill for the code per month.
Patient Agreement and Consent
Before providing or billing for CCM services, providers must obtain a patient’s verbal or written consent. The consent must be documented in the patient’s medical record and must show that the patient was informed of:
- The availability of CCM services
- Any applicable cost-sharing, including deductibles, co-pays, and co-insurance
- That only one practitioner can furnish and be paid for CCM services per month
- The right to stop CCM services at any time (effective at the end of the calendar month)
How to Bill for CPT 99490
To bill for CPT 99490, providers must:
- Document at least 20 minutes of non-face-to-face time spent by clinical staff providing Chronic Care Management (CCM) services within a given month.
- Record key details, including the date, time spent, name of the provider, and services performed.
- Submit claims to Medicare using CPT code 99490 (once per month per participating patient).
Additional Codes for CCM Services
Providers may also bill CPT 99439 alongside 99490 to account for additional time spent on CCM services. Additional relevant CPT codes include:
- CPT 99487 – Complex CCM services, requiring at least 60 minutes of clinical staff time.
- CPT 99489 – Add-on code to CPT 99487 for each additional 30 minutes of clinical staff time.
For the latest Medicare reimbursement rates, visit the CMS Physician Fee Schedule.
How Can BlueFish Medical Help You Bill for CPT 99490?
If you are considering offering CCM services or struggling to implement them in your practice, BlueFish Medical can help. BlueFish extends your medical practice by:
- Identifying eligible patients
- Recruiting and enrolling patients
- Documenting consent in the EHR
- Creating customized care plans
- Delivering care via our nursing staff
- Managing billing and documentation within your EHR
By managing CCM services, BlueFish allows providers to focus on face-to-face encounters while generating revenue from non-face-to-face visits. Practices can net approximately $55 per patient per month for CCM services. A practice with 1,000 CCM patients could generate at least $55,000 per month or $660,000 per year. BlueFish earns a percentage of the reimbursement, and the practice benefits from improved patient health outcomes and increased revenue.
To learn more about how BlueFish Medical can implement a successful CCM program for your practice, fill out the form below.
Editor’s Note: Updated February 2025