BALANCING KIDNEY CARE

MATCHING PATIENTS TO PROGRAMS FOR SUCCESS IN FFS AND VBC

ft. Jennifer Huneycutt CPA, CMPE of Metrolina Nephrology Associates

CHRONIC CARE MANAGEMENT GUIDELINES

2024 CHRONIC CARE MANAGEMENT (CCM) CPT CODES

Practices that use Phamily can generate over $300 per patient in extra profit annually.

2024 Chronic Care Management (CCM) CPT Code Summary

Download your free 2024 CCM codes summary and Implementation Guide

2024 CCM CPT Codes

Chronic Care Management Billing Codes Summary​

Chronic Care Management (CCM) is a new Medicare program that offers significant monthly reimbursement for the time providers and their staff spend helping patients between office visits.

CCM reimburses an additional $64-$177+ per patient per month for the support you and your staff regularly provide patients between visits.

CMS continues to increase the number of Chronic Care Management codes providers can bill for. Starting with just one code in 2015, CPT 99490, the Physician Fee-Schedule now includes 8 codes accounting for various levels of complexity and time.

CCM Code

Description

Reimbursement

CPT 99490 – Standard CCM

  • 20+ minutes of care management outside of office visits performed by clinical staff
  • Care plan established and regularly reviewed
$61.56
CPT 99439 – Non-complex Add on
  • Additional 20 minutes of “non-complex”
  • CCM Reportable up to 2x per month (after 99490)
$47.15 x 2
CPT 99487 – Complex CCM
  • 60+ min of care management outside office visits
  • Care plan created and/or significantly revised
$131.96
CPT 99489 – Complex CCM
  • Billed incrementally for each additional 30 minutes spent beyond the first 60 minutes for Complex CCM case
$71.05

HCPCS G0511 – RHC or FQHC

  • 20+ minutes of CCM or behavioral health integration services directed by a provider at a Rural Health Clinic or Federally Qualified Health Center

$78.91

HCPCS G0506 – Comprehensive Assessment & Care Planning
  • Patient enrolled in person Systematic assessment & care planning personally performed by the billing provider
  • Add-on code to the standard E&M code (99212-99215), AWV or IPPE initiating visit

$61.56

CPT 99491 – Physician-provided CCM
  • 30+ minutes of care management outside of office visits
  • Provided personally by a physician or other qualified healthcare professional

$83.17

CPT 99437 – Physician-provided CCM Add-on
  • Additional 20 minutes of care management outside of office visits
  • Provided personally by physician or other qualified healthcare professional

$58.61

Admin Activities

Care Coordination

Care management

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