Chronic Care Management (CCM) is a program recognized by the Centers for Medicare and Medicaid Services as an improvement to primary care and patient health. By enrolling patients in CCM, doctors are now able to monitor their patient's health on a monthly basis while also being reimbursed for their time. "Non-face-to-face" engagements such as filling prescriptions, reviewing the patient's care plan, and making simple phone calls are now billable through this program. 

What You need to know:

Requirements for Patient Enrollment:

  • Have two or more chronic conditions

  • Be put at serious health risk or risk of death due to these conditions 

  • Consent to CCM Services

  • Has had an office visit within the last 12 months

20  minute rule - a patient must receive at least 20 minutes of "non-face-to-face" clinical staff time directed by a qualified health care professional in a given month to be billable for CCM. 

CMS Requirements for Providers who wish to Participate in CCM:

  • Must use certified EHR Technology

  • 24/7 Access to care Management Services

  • 20 minutes of "non-face-to-face" clinical staff time needs to be spent on a patient in order to bill 

  • Documentation of time spent with patient

  • Monthly Reports and Summary of CCM

  • Comprehensive Patient-Centered Care Plan must be established

  • Care Plan must be available 24/7 to entire staff

  • Care Plan must be shared with EHR and other providers

How ThoroughCare makes it easy:

  • We provide an Initial Care Plan Assessment which automates the process of developing an individualized Care Plan for the patient 

  • 24/7 Access to your ThoroughCare site

  • Time logged for patients is recorded and documented in case of an audit

  • Options to create/print Patient-Centered care plans

  • Ability to generate Monthly Reports and Summaries 

The time your Care Managers spend on a patient in a given month does not have to stop at twenty minutes. If 60 or more minutes of "non-face-to-face" time is spent on a given patient a higher reimbursement is given with a different CPT code. 

CCM CPT Codes:

  • Code 99490 - At least 20 minutes of CCM time (reimbursement $40-45)

  • Code G0511 - At least 20 minutes of CCM time for RHCs and FQHCs) (reimbursement $67.02

  • Code 99439 - bill 99490 plus 99439 for a total of $79.80 (can be used up to two times a month)

  • Code 99487 - At least 60 minutes of Complex CCM time (reimbursement $90-95)

  • Code 99489 - Add this code to 99487 for every additional 30 minutes beyond 60 minutes (reimbursement $45-50 on top of $90-95)

  • Code 99491 - At least 30 minutes of CCM time provided by a physician (reimbursement $84.00)

The CCM program allows clinical staff to work with patients to set attainable goals and overcome common barriers they may face. The Care Managers are expected to check in on their patients in order to track goal and barrier progression. However, many tasks such as writing emails, filling prescriptions, reviewing lab results, and referrals can all be counted toward the 20 minutes of "non-face-to-face" time.

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