CPT codes for chronic care vary depending on who provides the service, as well as its complexity. Each code reflects a different value and the amount of time dedicated to care management.
In the following section, we break down the various types of billing codes for CCM.
CPT Codes for Non-complex Chronic Care Management
For the reimbursement of non-complex chronic care by clinical staff, the following rates apply. They are based on national averages, which may vary by the locality:
CPT code 99490 for 20 minutes of billable time at a $62 reimbursement
CPT codes 99490 + 99439 for 40 minutes of billable time at a $109 reimbursement
CPT codes 99490 + 99439 (x2) for 60 minutes of billable time at a $156 reimbursement
For rural health clinics (RHCs) and federally qualified health clinics (FQHCs), the following CPT code for "general care management" would apply for CCM.
CPT code G0511 for 20 minutes of billable time at a $76 reimbursement
When billing for chronic care services, you must present two ICD-10s (as CCM requires two or more conditions to be present).
You can only bill for one series of CCM services per patient, per month. For example, you can only submit a claim for either non-complex CCM or complex CCM. Not both.
CPT Codes for Physician-driven, Non-complex Chronic Care Management
CCM services are not reliant on clinical staff; some physicians are more hands-on than others.
The following billing codes were created to reflect the value of these physicians’ time.
They are for non-complex chronic care, where the provider or non-physician practitioner (NPP) is heavily involved. They cannot be billed concurrently with standard CCM CPT codes.
For non-complex care driven by the physician, you would use the following billing codes:
CPT code 99491 for 30 minutes of billable time at an $83 reimbursement
CPT codes 99491 + 99437 for 60 minutes of billable time at a $142 reimbursement
CPT Codes for Complex Chronic Care
For complex care, the following billing codes apply:
CPT code 99487 for 60 minutes of billable time at a $130 reimbursement
CPT codes 99487 + 99489 for 90 minutes of billable time at a $198 reimbursement
It is important to note that CPT code 99487, which accounts for 60 minutes of complex chronic care, differs from 60 minutes of non-complex CCM service. The distinction is clear. But it’s key to utilize the correct code when providing complex care.
In the case of an audit by Medicare, you’ll want to show the correct code was applied based on the situation. Some providers have run into trouble by failing to bill the accurate code.
What is the ROI of Chronic Care Management?
While the phrase return on investment (ROI) holds a financial connotation, a “return” isn’t entirely dependent on monetary value. General benefits are equally important, especially with regard to a person and their health.
Your patients will benefit from CCM because it places a preventive eye on their health.
As for CCM reimbursement rates, what is the revenue opportunity of the program?
The final figure in the graphic does not account for complex or physician-driven CCM services. Nor does it include additional billable time beyond the 20-minute minimum. Both could produce a higher figure.
Offering a CCM program can generate revenue, and it can recover costs and broaden care access for your patients. The combination is inherently valuable.
Streamline CCM With Care Coordination Software
To deliver and document CCM services, you’ll want a system in place to manage your program.
A practical resource, such as care coordination software, will keep key details from being lost or overlooked. This will promote efficiency for you and your staff and help patients succeed. Care coordination software can streamline the creation of patient care plans, support staff workflows, and simplify billing. ThoroughCare’s software solution offers these exact features.
With a clinician’s eye, we’ve designed an intuitive platform that untangles the entire CCM process, so you and your patients can capitalize on it. Our care coordination software solution enables you to offer a whole suite of wellness services that pair well with CCM, such as Behavioral Health Integration (BHI) or Remote Patient Monitoring (RPM).