CPT code 99490 Standard 20 Minutes of CCM Services

CPT code 99490 is the primary billing code for non-complex Chronic Care Management (CCM) services. It is used to bill CMS for the first 20 minutes of non-face-to-face CCM services, such as telephonic care provided by clinical staff under the guidance of a physician or qualified healthcare professional. These 20 minutes can be delivered in a single session or spread out over 30 days. Code 99490 can be billed once per calendar month, for every month of the year.

Billing Requirements for CPT 99490

To qualify for CCM services under CPT code 99490, patients must have two or more chronic conditions. These conditions must be expected to last at least 12 months or until the patient’s death, and they should pose a risk of acute exacerbation, functional decline, or death. Additionally, code 99490 requires the creation of a comprehensive care plan overseen by a physician. This care plan should be regularly reviewed and updated as needed. Services billed under code 99490 must address the patient’s chronic conditions and should not include time spent managing acute illnesses.From March 9 to December 31, 2024, the national average reimbursement rate for CPT code 99490 will be $62.59*. Actual reimbursement may vary depending on the provider and region.

CPT Code 99439 Additional 20 Minutes of CCM Services

CPT code 99439 is used to bill CMS for each additional 20 minutes of non-complex Chronic Care Management (CCM) services provided by clinical staff under the supervision of a physician or qualified healthcare professional. This code is an add-on to CPT code 99490.

Billing Requirements for CPT 99439

Code 99439 can be billed up to two times per month. When combined with code 99490, providers can bill for a total of up to 60 minutes of non-face-to-face, non-complex CCM services per month.The average reimbursement for CPT code 99439 in 2024 is approximately $48*.

CPT Code 99491 Initial 30 minutes of CCM Care Provided by a Physician or Nurse Practitioner

CPT code 99491 is used to bill for the first 30 minutes of non-complex Chronic Care Management (CCM) services that are personally provided by physicians, nurse practitioners, or qualified healthcare professionals each calendar month. Similar to code 99490, patients must have a diagnosis of at least two chronic conditions expected to last 12 months or longer, or until death.

Billing Requirements for CPT 99491

To bill under code 99491, the patient’s chronic conditions must pose a significant risk of death, acute exacerbation, or functional decline. A physician or nurse practitioner must develop and implement a comprehensive care plan tailored to the patient’s specific risk factors, medical history, and conditions. This plan should be monitored and updated as necessary.CPT code 99491 differs from code 99490 in two key ways: it requires a minimum of 30 minutes of care, and the care must be personally provided by a physician, nurse practitioner, or other qualified health professional. The national average reimbursement for CPT code 99491 in 2024 is $83.18*.

CPT Code 99437 Additional 30 minutes of CCM Care Provided by a Physician or Nurse Practitioner

CPT code 99437 is used alongside code 99491 and covers each additional 30 minutes of Chronic Care Management (CCM) services personally provided by physicians, nurse practitioners, or qualified health professionals.

Billing Requirements for CPT 99437

The eligibility criteria for CPT code 99437 are the same as those for code 99491. The care must be delivered by a physician, nurse practitioner, or other qualified health professional. Code 99437 can only be billed up to two times within a single month.The national average reimbursement for CPT code 99437 in 2024 is $58.62*.

CPT Code G0511 Care Management Services for RHCs and FQHCs

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) both utilize code G0511 to bill for a range of care management services, including Chronic Care Management (CCM), Principal Care Management, Behavioral Health Integration (BHI), Remote Patient Monitoring (RPM), Chronic Pain Management, and more. The billing criteria for CCM services under G0511 are the same as those for CPT codes 99490 and 99439.

Billing Requirements for G0511

Beginning in 2024, RHCs and FQHCs can bill G0511 multiple times within a month for various care management services, as long as the resources, costs, and time for each service are separately documented. For instance, a practice may bill G0511 three times in a single month—once for CCM, once for BHI, and once for RPM. This also allows billing for multiple increments of 20 minutes of CCM services, similar to the use of code 99439 in conjunction with code 99490.Despite covering multiple services, G0511 can only be billed once per calendar month. Practices are advised to wait until the end of the month to submit the G0511 claim, ensuring that all care management services are properly accounted for.From March 9 to December 31, 2024, the national average reimbursement rate for G0511 will be $74.20. The actual amount may vary by region for FQHCs, but RHCs are expected to consistently receive this payment.

CPT code 99487 60 Minutes of Complex CCM Services

CPT code 99487 is used to bill CMS for the first cumulative 60 minutes of non-face-to-face Chronic Care Management (CCM) services provided to patients with complex chronic conditions by clinical staff. Introduced by Medicare in 2017, this code allows reimbursement for patients requiring more extensive care than what is covered under the standard 20-minute time frame billed with code 99490.It's important to distinguish between code 99487 and codes 99491 and 99437. Code 99487 is specifically for 60 minutes of non-face-to-face, complex CCM services provided by non-physician practitioners and clinical staff, whereas codes 99491 and 99437 apply to a combined 60 minutes of in-person, non-complex CCM care provided by physicians. These codes cannot be billed together within the same calendar month.

Billing Requirements for CPT 99487

The eligibility requirements for billing code 99487 mirror those of code 99490. The patient must have two or more chronic conditions expected to last at least 12 months or until death, and these conditions must pose an acute risk of exacerbation, death, or functional decline. An individualized care plan must be developed and consistently monitored and updated throughout the patient’s treatment.The national average reimbursement for CPT code 99487 in 2024 is $131.97*.

CPT code 99489 Additional 30 Minutes of Complex CCM Services

CPT code 99489 is an add-on to code 99487 and is used to bill for each additional 30 minutes of non-face-to-face, complex Chronic Care Management (CCM) services provided by clinical staff. While code 99487 covers the initial 60 minutes of care in a given calendar month, any further complex CCM services should be billed using code 99489.

Billing Requirements for CPT 99489

The eligibility criteria for billing code 99489 are the same as for code 99487. There is no limit to how many times a provider can bill code 99489 in a single month. These codes were introduced to accommodate patients requiring several hours of complex chronic care services each month.The national average reimbursement for CPT code 99489 in 2024 is $71.06*.