Chronic care management (CCM) is a model of care recognized by the Centers for Medicare and Medicaid Services (CMS) for the treatment of chronic care patients. First introduced in 2015, CPT® Code 99490 for CCM services has been joined by four other CPT Codes in the years since, including revisions as recently as January 1, 2022. With that in mind, here’s an updated look at CCM codes in 2022.
> Looking for a primer on chronic care management? Check out our overview of CCM here.
CCM Codes: A Brief History
In 2015, the first CCM code was introduced. CPT Code 99490 provided for at least 20 minutes of time per calendar month for the treatment of a patient with two or more chronic conditions. Care was to be delivered by clinical staff, under the direction of a physician or other qualified health care professional. (This is usually abbreviated as QHP, or sometimes QHCP, and refers to a specialist or advanced practitioner like a physician assistant or nurse practitioner.)
In 2017, code G0506 was introduced to extend payments for care management and planning for patients with chronic conditions that go “beyond the usual effort” (in the AAFP’s words). G0506 is not a CPT Code but a HCPCS code, designed as an “add-on” to provide additional reimbursement for time spent providing CCM not covered in 99490.
By 2019, three more CCM codes were added to the list. CPT Code 99491 covered 30 minutes of time provided directly by a physician or other qualified health care professional (QHP, or sometimes QHCP). CPT Code 99487 and CPT Code 99489 reimbursed complex chronic care management, with 99487 covering 60 minutes of clinical staff time and 99489 covering each additional 30 minutes of time.
These CCM codes remain in place today, with some revisions to care criteria and reimbursement amounts over the years. Further changes can be expected, too, as the use of CCM gains traction in the United States, especially in conjunction with CPT Codes for remote patient monitoring (RPM, also known as remote physiologic monitoring).
With that in mind, let’s take a look at the current CCM codes in 2022.
CCM Codes in 2022: 99490, 99491, 99487, 99489 and G0506
Please note that the reimbursement amounts presented here represent non-facility national averages. Commercial amounts for each of these codes may differ by region. You can consult a local Medicare Administrative Contractor (MAC) to find out the exact reimbursement rates for your region.
CPT Code 99490
What is CPT Code 99490?
CPT Code 99490 reimburses time spent by clinical staff — under the direction of a physician or QHP — of care coordination for patients with two or more non-complex chronic conditions. Code 99490 covers 20 minutes of time for non-face-to-face care, per patient per month (PPPM).
What’s the reimbursement amount for code 99490?
CPT Code 99490 allows for $64.02 in reimbursement, PPPM (non-facility national average).
Any other details?
Code 99490 covers basic patient coordination services such as arranging follow-up appointments, refilling prescriptions, and requesting and updating medical records. All services must be included in the patient’s care plan.
CPT Code 99491
What is CPT Code 99491?
CPT Code 99491 reimburses time spent directly by a physician or QHP to manage care for patients with two or more non-complex chronic conditions. Code 99491 covers 30 minutes of time PPPM, with a maximum monthly amount of 60 minutes.
What’s the reimbursement amount for code 99491?
CPT Code 99491 allows for $86.17 in reimbursement, PPPM (non-facility national average).
Any other details?
Code 99491 covers care coordination that’s carried out by a physician or QHP, as opposed to other clinical staff under their direction, which is covered by 99490. And, as with 99490, all services provided must be included and documented in the patient’s care plan.
CPT Code 99487
What is CPT Code 99487?
CPT Code 99487 covers complex CCM, defined as patients with two or more chronic conditions who require “moderate or high complexity medical decision making,” as per CMS guidelines. Code 99487 reimburses 60 minutes of time spent by clinical staff under the direction of a physician or QHP.
What’s the reimbursement amount for code 99487?
CPT Code 99487 allows for a reimbursement of $134.27 PPPM (non-facility national average).
Any other details?
It’s important to note that a billing practitioner is not allowed to report both complex and non-complex CCM for any single patient. In other words, 99487 cannot be reported for the same patient in the same calendar month as 99490 or 99491.
CPT Code 99489
What is CPT Code 99489?
CPT Code 99489 covers each additional 30 minutes of complex chronic care management PPPM under the direction of a physician or QHP of care coordination, to be reported after the initial 60 minutes allowed for by 99487.
What’s the reimbursement amount for code 99489?
CPT Code 99489 allows for a reimbursement of $70.60 PPPM (non-facility national average).
Any other details?
“Report 99489 in conjunction with 99487,” as per CMS guidelines. “Do not report 99489 for care management services of less than 30 minutes additional to the first 60 minutes of complex CCM services during a calendar month.”
CCM Code G0506
What is CCM Code G0506?
CCM code G0506 covers comprehensive assessment and care planning for patients with two or more chronic conditions, as provided by a physician or QHP.
What’s the reimbursement amount for code G0506?
Code G0506 allows for a one-time reimbursement of $62.04 (non-facility national average).
Any other details?
G0506 is a Healthcare Common Procedure Coding System (HCPCS) code, designed by CMS to supplement CPT Codes. (CPT Codes, considered “Level I,” begin with numbers, while HCPCS codes, considered “Level II,” begin with letters.) So, G0506 can be billed separately from 99490, 99487 and 99489. But keep in mind, advises the AAFP, “that the time and effort described by G0506 cannot also be counted toward another code,” and that “G0506 can only be billed once per patient per provider.”
Looking for more guidance on the use of CCM codes in your organization?
If your organization is looking for ways to leverage CCM codes in patient care plans, we may be able to help! Contact us now to connect to a CareSimple specialist.
If you’re looking for not just CCM codes but also RPM, RTM, PCM and others, download our handy Reimbursement Tree for a convenient, up-to-date one-page summary.