Healthcare Insights
Top 8 chronic care management CPT codes
Millions of Americans are living with chronic diseases like heart disease, diabetes, and asthma. In fact, nearly 95% of older adults have at least one chronic condition, and 80% have two or more. Chronic care management (CCM) plays a vital role in supporting these individuals, helping them manage their health and improve their quality of life.
For healthcare providers, getting reimbursed for these services hinges on current procedural terminology (CPT) codes. These codes are the foundation for both billing and documentation. In this article, we look at the most common CCM CPT codes used to track procedures and services related to chronic care.
What is chronic care management (CCM)?
Chronic care management (CCM), also called chronic disease management, refers to a comprehensive healthcare service designed to support patients with chronic medical conditions. It involves coordinating care, managing medications, providing patient education, monitoring health metrics, and facilitating communication between healthcare providers. Chronic care management aims to improve the quality of life for patients, enhance health outcomes, and reduce healthcare costs associated with managing chronic diseases.
Medicare covers CCM services to support beneficiaries with two or more chronic conditions that are expected to last at least 12 months. Medicare's CCM program allows eligible healthcare providers to bill for non-face-to-face care coordination services provided to Medicare patients using CCM CPT codes.
Healthcare providers, including physicians, nurse practitioners, physician assistants, and clinical nurse specialists, can bill Medicare for providing chronic care management services. These services include activities such as creating or updating a comprehensive care plan, coordinating care with other healthcare providers, monitoring patient health remotely, providing medication management, and offering support for lifestyle changes.
By reimbursing healthcare providers for CCM services, Medicare aims to incentivize the provision of ongoing care management for patients with chronic conditions, ultimately improving health outcomes and reducing healthcare costs associated with preventable complications and hospitalizations.
What conditions qualify for chronic care management (CCM)?
Chronic conditions can encompass a wide range of medical conditions, including but not limited to:
- Diabetes mellitus
- Hypertension (high blood pressure)
- Heart disease (e.g., coronary artery disease, congestive heart failure)
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Chronic kidney disease
- Stroke
- Arthritis
- Alzheimer's disease or other dementias
- Cancer
- Depression
- HIV/AIDS
These are just examples, and there are many other chronic conditions that may qualify patients for CCM services. The key criterion is that the conditions require ongoing medical management and support, and they significantly impact the patient's health and daily functioning. It's essential for healthcare providers to assess each patient's individual health status and medical history to determine eligibility for CCM services under Medicare guidelines.
We compiled the top eight chronic care management CPT codes below to highlight which areas of CCM are seeing the most procedures.
| Rank | CPT code | CPT code description | % total procedures | Explore dataset |
|---|---|---|---|---|
| 1 | 99490 | Chronic care management services, first 20 minutes of clinical staff time per calendar month | 64.7% | Explore |
| 2 | 99439 | Chronic care management services, each additional 20 minutes of staff time per calendar month | 18.9% | Explore |
| 3 | 99487 | Complex chronic care management services, first 60 minutes per calendar month | 5.9% | Explore |
| 4 | 99491 | Chronic care management services, first 30 minutes provided by a physician per calendar month | 3.3% | Explore |
| 5 | 99489 | Complex chronic care management services, each additional 30 minutes per calendar month | 2.8% | Explore |
| 6 | 99484 | Care management services for behavioral health conditions, 20 minutes per calendar month | 2.6% | Explore |
| 7 | 99483 | Assessment & care planning for a patient with cognitive impairment | 1.5% | Explore |
| 8 | 99437 | Chronic care management services, each additional 20 minutes provided by a physician per calendar month | 0.3% | Explore |
Fig. 1 Data is from our Atlas All-Payor Claims Dataset for calendar year 2023. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed March 2024.
Which chronic care management CPT code has the highest number of procedures?
The 99490 CPT code accounted for the highest percentage of procedures in 2023, at 64.7%. This CPT code tracks chronic care management services for the first 20 minutes of clinical staff time per calendar month.
In the second position with 18.9% of total procedures, CPT code 99439 highlights the need for supplementary time beyond the initial 20 minutes for chronic care management services.
In third place, CPT code 99487, accounting for 5.9% of procedures, addresses the complexities inherent in managing chronic conditions. It suggests that there is also a significant demand for more complex chronic care management services requiring up to 60 minutes of clinical staff time per month.
Overall, these trends indicate most chronic care management procedures involve kickstarting the care process, adding extra time to visits, and handling complex cases. Healthcare providers can use this intelligence in choosing which treatments and services to offer.
What is the difference between CCM and PCM?
CCM (chronic care management) and PCM (primary care management) are both healthcare management services, but they serve slightly different purposes:
Chronic care management (CCM):
- CCM focuses on the ongoing care and support for patients with chronic medical conditions such as diabetes, hypertension, or heart disease.
- It involves coordinating care between different healthcare providers, monitoring patient health remotely, providing medication management, and offering support for lifestyle changes.
- CCM services are typically provided by clinical staff, such as nurses or medical assistants, under the supervision of another healthcare provider.
Primary care management (PCM):
- PCM is a broader term that encompasses a range of healthcare services aimed at managing and maintaining overall health and wellness.
- It includes preventive care, routine check-ups, management of acute illnesses, and coordination of referrals to specialists when necessary.
- PCM is typically provided by primary care physicians or other healthcare providers in primary care settings.
While both CCM and PCM involve managing patient care, CCM specifically targets ongoing care for chronic conditions, while PCM encompasses a wider range of healthcare services provided in primary care settings.
What is the difference between CPT code 99490 and 99491?
CPT codes 99490 and 99491 both relate to chronic care management services, but they differ in terms of the provider who delivers the service and the duration of the service provided. CPT code 99490 covers the initial 20 minutes of chronic care management services provided by clinical staff per month, while 99491 covers the first 30 minutes of these services provided directly by a physician.
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