Staying on top of Chronic Care Management (CCM) CPT codes allows your organization to get Medicare reimbursements on time and coordinate patient care efficiently. These benefits lead to cost-savings across departments—ultimately, protecting your bottom line and revenue cycle.
To fully optimize your Medicare reimbursements, here’s a list of relevant CCM CPT codes, their descriptions, and the associated costs for your remote patient monitoring (RPM) program.
| Complex Chronic Care Management CPT Codes | ||
|
99487 |
Minimum 60 cumulative minutes over a 30-day period of non-face-to-face consultation time establishing or monitoring a care plan. |
$131.97 |
|
99489 |
To be billed with CPT 99487 for every additional 30 minutes of non-face-to-face consultation. |
$71.06 |
| Chronic Care Management CPT Codes | ||
|
99490 |
Minimum 20 cumulative minutes over a 30-day period of non-face-to-face time monitoring the care plan. |
$61.57 |
|
99439 |
Subsequent 20 minutes of care provided by clinical staff. |
$47.16 |
|
99491 |
Initial 30 minutes of care personally provided by physician, or non-physician practitioner (NPP). |
$83.18 |
|
99437 |
Subsequent 30 minutes of care personally provided by a physician or NPP. |
$58.62 |
Want to learn more? Check out our free CPT billing guide today.
CPT 99487
Description: Minimum 60 cumulative minutes over a 30-day period of non-face-to-face consultation time establishing or monitoring a care plan.
CPT 99487 was introduced in 2017 to account for coordination of care extended to particularly complex patients. With this code, the first 60 minutes of non-face-to-face care coordination carried out by clinical staff is reimbursed by Medicare.
The differences between requirements for CPT 99487 and CPT 99490, which was introduced earlier in 2015, would be the longer 60 minutes of physician care time reimbursed, as well as the requirement for moderate or high complexity medical decision making for patients.
Other requirements and patient services provided to qualify for CPT 99487 reimbursement are:
- More than one chronic condition expected to last at least 12 months, or until death of patient.
- Chronic conditions that place the patient at a significantly higher risk of death, acute exacerbation/decompensation, or functional decline.
- Establishment or revision of a comprehensive care plan.
CPT 99489
Description: To be billed with CPT 99487 for every additional 30 minutes of non-face-to-face consultation.
CPT 99489 can be used as an add-on to CPT 99487 for additional time spent on care coordination services per calendar month. While CPT 99487 reimburses the first 60 minutes of a non-face-to-face consultation, CPT 99489 reimburses each additional 30 minutes spent on a session.
This code was introduced in 2017 in recognition of the fact that complex chronic care management patients often require several hours of non-face-to-face care coordination per month.
CPT 99490
Description: Minimum 20 cumulative minutes over a 30-day period of non-face-to-face time monitoring the care plan.
CPT 99490 allows non-face-to-face monitoring and non-complex CCM carried out by clinical staff, under the supervision of a doctor, to be reimbursed. The focus with this code is on reimbursing service for patients with two or more chronic conditions, preventing the escalation or worsening of these conditions.
Requirements to qualify for CPT 99490 are the same as CPT 99487 apart from a lower minimum time of 20 minutes of provided care.
CPT 99439
Description: Subsequent 30 minutes of care provided by clinical staff.
Working in tandem with CPT 99490, CPT 99439 can be used every month for additional 30 minutes of care provided for non-complex CCM performed by clinical staff, with supervision of a doctor.
CPT 99491
Description: Initial 30 minutes personally provided by physician, or non-physician practitioner (NPP).
Introduced in 2019, CPT 99491 was added to reimburse a minimum 30 minutes of personal care provided by doctors and nurse practitioners. This code is an add-on to code 99490 with similar patient eligibility criteria of two or more chronic conditions, a significant risk of death, acute exacerbation, or functional decline and the establishment of comprehensive care.
The differentiators between the two codes are that CPT 99491 requires:
- CCM services to be provided personally by doctors and nurse practitioners
- A minimum 30 minutes of CCM care per month.
CPT 99437
Description: Subsequent 30 minutes of care personally provided by physician or NPP.
CPT 99437 is an add-on code to CPT 99491 for additional time beyond the initial 30 minutes of care covered by 99491.
The same eligibility criteria and requirements apply for CPT 99437 as for CPT 99490, 99439, and 99491. Similar to CPT 99491, all care must be provided personally by a doctor, NP, or other qualified healthcare professional to qualify for reimbursement under CPT 99437.
Access Our Comprehensive Guide to CCM CPT Codes
For more resources on Medicare reimbursement updates, CPT codes, and best practices for your RPM billing, feel free to reach out to our team of reimbursement experts.
