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Key Takeaways
- Medicare chronic care management (CCM) supports qualifying care coordination between office visits.
- Patients generally need two or more qualifying chronic conditions.
- Consent, an appropriate care plan, and access to ongoing care must be documented.
- CPT 99490 and 99439 count qualifying clinical staff time.
- CPT 99487 and 99489 apply to complex CCM when additional requirements are met.
- Accurate monthly time records and code selection help reduce denials and audit exposure.
CCM billing requirements determine when a medical practice can bill Medicare for qualifying chronic care management. The service helps people with multiple chronic conditions who need ongoing coordination between appointments. However, they can be paid only if they meet specific clinical, documentation, and time requirements.
A practice can’t send a bill just because someone called a customer or changed a drug list. The record must show that the patient is eligible for the covered service and that the time limit has passed.
Instead of using an old code outline, practices that are setting up or reviewing a CCM program should use the most recent CMS advice. Credex Healthcare helps companies that are looking at their coding and claim processes by providing CCM billing services.
Rules reviewed for this article as of October 2026. Before sending in claims, make sure you understand the latest CMS guidelines and CPT code descriptions.
What Is Chronic Care Management?
Medicare’s chronic care management service pays doctors and other health care professionals who coordinate care for patients with multiple chronic conditions during a calendar month. The work gets done a lot when meetings are not in person.
As part of the service, treatment may be coordinated, medicines may be reviewed, communication with other providers may be maintained, a complete care plan may be updated, and patients may be given help with managing their ongoing health needs.
CCM is not the same as a regular office visit. Before reporting the relevant code, the practice must make sure that all of the eligibility, consent, care plan, and time requirements are met.
The Chronic Care Management Services booklet is one of the new resources CMS has released. You can find it in the Care Management section.
Who Qualifies for CCM?
Medicare CCM is usually given to people who have two or more long-term diseases that are expected to last at least one year or until death and that put the person at high risk of dying, getting worse quickly, or losing their ability to do things.
Like diabetes and high blood pressure, or chronic obstructive lung disease and heart disease. The list of diagnoses is not enough on its own. The doctor or nurse must ensure the patient meets the eligibility requirements.
Often, primary care and internal medicine practices care for patients with multiple long-term conditions. Their records should clearly show what the patient needs and why ongoing care planning matters.
See Credex Healthcare’s primary care billing and internal medicine billing resources for related specialty billing considerations.
CCM Billing Requirements Checklist
Make sure you meet the following requirements before you report a CCM claim.
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Complete the Initiating Visit When Required
A qualifying starting visit is usually needed before CCM can start for a new patient or a patient who hasn’t seen the practitioner in the past year.
CMS says that an Initial Preventive Physical Examination (IPPE), an Annual Wellness Visit (AWV), or a full face-to-face evaluation and management (E/M) visit is an acceptable choice for the first visit.
The first visit is not the same as the ongoing CCM service. Read the most recent CMS CCM guidance to make sure you understand the criteria.
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Obtain and Document Patient Consent
Before starting CCM, the practitioner must obtain permission and document it in the patient’s medical log. CMS allows either spoken or written agreement as long as the necessary conditions are met.
The patient should know what the service is, that they may have to pay for some of it, and that they can stop CCM services at any time. The record should show that the necessary information was provided.
People who agree to general treatment should not be used as proof of CCM consent unless the paperwork meets the requirements.
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Create and maintain a comprehensive care plan
The office has to create and maintain an electronic care plan that is focused on the patient and their long-term illnesses and care needs.
The plan could include the following, depending on the patient:
- A list of billing issues and projected outcomes
- Measurable treatment plans
- Planned interventions and drug control
- Symptom monitoring and management
- Provider and community resources collaboration
- Patients need review and updates
CMS also says the office must give the patient or their caretaker a copy of the care plan. A template by itself doesn’t show that the plan meets the real needs of the patient.
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Provide Access and Continuity of Care
Access to care and continuity between visits are both required by CCM. The practice must follow rules for after-hours care, track important patient information, and coordinate with other doctors treating the patient.
Care coordination can include a phone call or message, but the practice needs to keep track of the work that meets the criteria.
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Track Qualifying Time
When needed to back up the stated code, write down the date, the type of action, the staff member or practitioner who did it, and the amount of time spent on it.
Don’t count time that the rules don’t allow for writing. Don’t count the same work twice for services that overlap or report the same time toward code thresholds that don’t work together.
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Check the Monthly Billing Restrictions
It is common for a month to be used as the work period for which CCM is recorded. Before sending the claim, the practice must ensure the patient is eligible, the practitioner is responsible, the correct code family is used, and there are no limits on shared services.
CMS rules say that a patient can only have one practitioner bill CCM for them in a month, and they can’t report more than one type of CCM for the same service period. Check out the most recent CMS Frequently Asked Questions to find out exactly what happened.
CCM CPT Codes and Time Thresholds
The correct CPT code depends on the type of CCM provided, who performs the work, the documented time, and the complexity requirements.
| CPT code | Service | General time threshold |
| 99490 | Non-complex CCM using clinical staff time under practitioner direction | First 20 minutes per calendar month |
| 99439 | Additional non-complex CCM using clinical staff time | Each additional 20 minutes |
| 99491 | CCM furnished personally by the billing practitioner | First 30 minutes per calendar month |
| 99437 | Additional practitioner time for CCM | Each additional 30 minutes |
| 99487 | Complex CCM using clinical staff time | First 60 minutes per calendar month, plus required medical decision-making complexity |
| 99489 | Additional complex CCM | Each additional 30 minutes |
These thresholds reflect the code structure in the CMS CCM booklet. Confirm the current-year descriptors and reporting rules against the applicable CPT definitions and CMS guidance before billing.
What Is the Difference Between CPT 99490 And 99491?
This CPT 99490 code counts the first 20 minutes of qualifying clinical staff time that the billing practitioner gives them. CPT 99491 only counts the first 30 minutes of qualified time that the billing practitioner spent on the job.
What makes the difference is who does the work and how long it takes. Clinical staff’s personal time does not meet the 99491 thresholds.
For instance, if clinical staff do 20 minutes of eligible CCM work every month, the practice may meet the basic time threshold for 99490 as long as all the other requirements are met. You don’t have to pay for the code just because the deadline passed.
What Qualifies as Complex CCM Billing?
For complex CCM, CPT 99487 and its add-on code 99489 are used when the necessary paperwork and service standards are met.
The first 60-minute limit is not enough on its own. Complex CCM also requires moderately or highly complex medical decisions and a substantially updated comprehensive care plan, depending on what the code says.
Do not choose a complicated CCM just because a patient has a lot of diagnoses or wants to talk to you a lot. The record has to meet the criteria for service and complexity.
Accurate medical coding services can help practices review their paperwork, select the right codes, and ensure their claims are correct.
Billing CCM With Other Services
In some cases, CCM can be provided along with other tracking or care management services, but practices need to make sure they know the Medicare rules for each combination.
CCM And Transitional Care Management
Transitional care management (TCM) ensures people receive the right care as they move from the hospital to home. If a practice also offers CCM during the time period in question, it needs to check the current CMS rules for both services, including deadlines, who is eligible, and any limits that may apply.
CCM And Principal Care Management
Principal care management (PCM) is the process of managing a single, complicated, long-term, or high-risk illness according to its specific needs. Do not bill PCM and CCM for the same patient and time period at the same time. Before reporting either service, make sure you know the current code-specific rules.
CCM And Remote Patient Monitoring
Remote patient monitoring, or RPM, includes getting tracking services approved and doing management work that goes along with it. Some offices provide both RPM and CCM, but each service needs to meet its own standards. When the rules say not to, the practice must not count the same work or time twice.
CCM in FQHCs and RHCs
Federally qualified health centers and rural health clinics can be paid and billed in different ways. Their rules aren’t the same as standard physician office billing.
Check out the FQHC billing guidelines to learn more about the specific encounter and payment rules that FQHCs must follow. Instead of a general compatibility guide, use the most up-to-date CMS directions for every service bundle.
Common CCM Billing Errors Auditors Flag
A big part of CCM checks is verifying that the paperwork supports the claim. Some common risk areas are:
- Patient approval is missing or incomplete.
- There isn’t a qualified initial visit when one is needed.
- Timesheets that don’t match the code that was billed.
- A care plan that isn’t there, isn’t complete, or wasn’t given to the patient.
- Duplicate time between services or billing that happens at the same time.
- Claims were submitted without confirming the patient’s eligibility or the practitioner’s responsibility.
- CCM codes are too complicated without supporting documentation.
A practice should investigate patterns instead of correcting only individual claims. For broader denial prevention, review common medical billing denials and how to prevent them.
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Running CCM In-House or With a Billing Partner?
With an in-house CCM process, a practice has full control over contacting patients, assigning staff, maintaining records, and submitting claims. It also needs training, accurate timekeeping, and regular reviews of how charging needs to change.
A billing partner might help practices look over claims, organize checks on documentation, find mistakes that keep happening, and handle the administrative work. The practice still needs clinical oversight and needs to make sure that the services meet Medicare’s needs.
Compare outsourcing vs. keeping billing in-house before choosing an approach. Practices with several specialties can also review Credex Healthcare’s specialty medical billing services.
FAQs
Does the patient have to consent to CCM?
Yes. Before CCM starts, the practitioner must obtain consent and document it. The patient must be told what they need to know, such as that they may have to pay some of the costs and that they can stop the service at any point.
Can more than one practitioner bill CCM for the same patient in a month?
In most cases, Medicare rules say that only one practitioner can bill CCM for a patient in a calendar month. Before sending, practices should look for other CCM claims and make sure the service period is correct.
How much time is needed for CPT 99490?
In most cases, CPT 99490 only counts the first 20 minutes of qualified clinical staff time that the billing practitioner directs in a calendar month. The practice must also meet all other CCM requirements, such as ensuring patients are eligible and maintaining good records.
Can CCM and TCM be billed in the same month?
The answer depends on the rules that apply to the CMS and whether each service meets its own needs. Practices must review the most recent guidance for this code mix and ensure time isn’t wasted or counted twice.
Strengthen Your CCM Billing Process
Medicare patients eligible for CCM can receive ongoing care, but payment depends on the services provided and the paperwork to support them. The billing process should start with clear consent forms, an up-to-date care plan, accurate time tracking, and choosing the right codes.
After policy changes, review the program again, and if claim problems keep happening, investigate them before they get worse. For help reviewing documentation, code selection, and claim workflows.
Let Credex manage your CCM billing.
Schedule a free consultation to discuss your practice's CCM billing requirements.
