• Medicare and private payers cover chronic care management services if a patient has two or more serious conditions that are expected to last at least a year.
• Medical offices often question the correct way to code for CCM for Medicare. CodingIntel provides the correct way to utilize CPT^® 99490, 99439, 99491, 99437, 99487, and 99489.
• See also Principal Care Management
• And, download our Care Management Coding Guide and CCM Quick Reference Sheet

Use of CPT^® codes 99490, 99439, 99487, 99489, 99491 and HCPCS code G0506

Chronic care management services are service provided to patients who have medical and/or psychosocial needs requiring establishing, implementing and monitoring a care plan. By definition, they are for patients who have two or more chronic illness expected to last for at least 12 months, or until the death of the patient, that place them at significant risk of death, acute exacerbation/decompensation or functional decline.

Some of the codes describe care provided by a physician or non-physician practitioner (NPP), and some describe services performed by clinical staff under the supervision and direction of a physician or NPP. If a physician or NPP provides the service, do not double count time spent in any other, billable activity.  All are for time during a calendar month.

Chronic care management does not require moderate or high MDM. “Both chronic care and complex chronic care management address, as needed, all medical conditions, psychosocial needs, and activities of daily living.”  ^[1]

Additional requirements:

• CMS requires verbal or written consent from the patient, and this consent must be documented in the medical record.
• Development of a comprehensive care plan.
• The patient must have a designated physician/NPP as their clinician and have 24/7 access to address urgent needs.
• The practice must use a certified electronic health record, although faxing is allowed to share the care plan.
•  Use a standardized method to identify patients who are eligible for the service.
• Manage care transitions.
• Give a copy of the plan to the patient.
• For CMS, supervision is general. The physician or NPP who is supervising the work done by clinical staff does not need to be in the same place when the work is done.

Complex chronic care management

For complex chronic care management, CPT says, “Typical patients have complex diseases and morbidities and, as a result, demonstrate one or more of the following::

• need for the coordination of a number of specialties and services;
• inability to perform activities of daily living and/or cognitive impairment resulting in poor adherence to the treatment plan without substantial assistance from a caregiver;
• psychiatric and other medical comorbidities (eg, dementia and chronic obstructive pulmonary disease or substance abuse and diabetes) that complicate their care; and/or
• social support requirements or difficulty with access to care. ^[2]

Complex chronic care management addresses all of the patient’s chronic medical problems. Complex chronic care management has longer threshold times to bill, as well. Typical patients receiving chronic care management have three or more prescriptions and may be receiving other therapeutic interventions.

99487 and 99489 are time-based services performed by clinical staff members under the supervision of a physician or NPP

99487 Complex chronic care management services, with the following required elements:

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• Establishment or substantial revision of a comprehensive care plan,
• Moderate or high complexity medical decision making;
• 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

+ 99489 each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

Chronic care management

There are two sets of chronic care management codes (separate from complex chronic care management, discussed above). One is for work done by the physician/NPP and the other is for work performed by clinical staff under the supervision of a physician/NPP.

Codes for CCM performed by clinical staff

99490 Chronic care management services with the following required elements:

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline,
• Comprehensive care plan established, implemented, revised, or monitored;

First 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.