Struggling to apply the correct CCM CPT codes for initial and extended care? Let us break down the differences so you can choose the right code for every situation. Chronic Care Management (CCM) services are a significant part of primary care. But did you know they are equally beneficial for both practices and patients? While they help patients effectively manage their chronic conditions, they optimize your revenue.
With approximately 129 million people in the country diagnosed with at least one major chronic disease, it is easy to assume that primary care providers get paid on time. However, they often experience high denial rates due to coding mistakes. Let’s discover this year’s popular CCM CPT codes so you don’t face the same thing!
What is Chronic Care Management?
Do you often serve people with long-term health issues? Then you might be familiar with their requirements. Chronic Care Management (CCM) is a complete set of services designed to help such patients effectively manage their health. In simple words, CCM is a holistic care plan that includes a patient’s health problems, goals, medications, and other information.
Primary care providers, including licensed physicians, nurses, and physician assistants, often provide these services to patients enrolled in Medicare or any other valid insurance plan. But what is the eligibility criteria? Medicare beneficiaries must meet the following conditions to qualify for CCM:
- They must have at least two chronic conditions.
- These conditions should last for at least one year.
- Patients must be at significant health risk, which may include deteriorating health, acute exacerbations, decompensation, or even death.
Most Common CCM CPT Codes 2024
The Centers for Medicare and Medicaid Services (CMS) introduced CCM CPT codes so doctors could receive fair compensation. However, annual coding updates, varying time parameters, and insufficient administrative resources make the coding process for chronic care more complex.
You can overcome this issue by familiarizing yourself with the popular codes. So, without further ado, here are this year’s most common CPT codes for chronic care management.
CPT Codes for Chronic Care Management of a Single Condition
CPT Code 99424 – Chronic Care Management (First 30 Minutes)
This CCM CPT code covers management and care plan services for a patient with a complex chronic condition. To be more specific, billing teams use CPT code 99424 when a physician or other qualified healthcare professionals spend the first half an hour on a care plan to manage a patient’s persistent illness.
This severe illness can usually last up to three months and has a high risk of severe outcomes.
CPT Code 99426 – Clinical Staff-Led Complex Chronic Care (First 30 Minutes)
Some patients require extra attention! This CCM CPT code reports high-level care for patients with a single chronic condition. You can use the 99426 CPT code if your clinical staff under a healthcare provider’s supervision has spent the first 30 minutes providing extra support to patients in a month.
Complex chronic care management differs slightly from standard services. These often involve significant revisions to a comprehensive care plan and high-level medical decisions.
Add-On CPT Codes for Managing a Single Chronic Condition
CPT Code 99425 – Additional Complex Chronic Care (30 Extra Minutes)
You can pair this code with the 99424 CCM CPT code. In simpler terms, the 99425 CPT code can help healthcare providers claim reimbursement for each extra 30 minutes they spend on managing the chronic condition of a high-risk patient beyond the initial half an hour.
CPT Code 99427 – Additional Clinical Staff-Led Complex Care (Extra 30 Minutes)
This add-on CPT code is used with the 99426 CPT code. Some cases are so complicated that they may require extra time. Hence, billing specialists use this code to notify payers about clinical staff spending more time (each additional 30 minutes beyond the initial half an hour) managing a chronic patient’s complex care plan.
CPT Codes for Chronic Care Management Services (At Least 2 Conditions)
CPT Code 99490 – Chronic Care Management Services (First 20 Minutes)
This CPT code falls within the range of chronic care management services. Billing experts use the 99490 CCM CPT code when clinical staff under the healthcare provider’s supervision supports a patient’s care across different specialties.
However, there are some conditions. This code only covers the first 20 minutes of provider-directed clinical staff’s time in a month. Moreover, you can only apply CPT code 99490 to critical patients: those with at least two chronic conditions who are at high risk for serious health issues.
CPT Code 99487 – Complex Chronic Care Management (First 60 Minutes)
This CPT code covers the first full hour of complex chronic care management in a month. Simply put, you can apply CPT code 99487 when your clinical staff spends 60 minutes managing a patient’s care under a healthcare provider’s guidance.
Remember that billing specialists can only apply this code for services provided to patients with two or more chronic conditions with a high risk of health deterioration.
CPT Code 99491 – Physician-Directed Chronic Care Management Services (First 30 Minutes)
This CCM CPT code addresses the direct involvement of a physician or any other certified healthcare professional in chronic care management. Specifically, you can use the 99491 CPT code when a doctor personally oversees a chronic patient’s care plan.
These patients have long-lasting health problems, which can lead to major health risks, including deteriorating health or even death. This code covers the first 30 minutes of a physician’s time in a month.
Add-On CPT Codes for Managing At Least 2 Chronic Conditions
CPT Code 99439 – Additional Chronic Support (20 Extra Minutes)
This CCM CPT code addresses the additional support. To be more precise, you can use it to bill for each additional 20 minutes that your clinical staff spends under a healthcare provider’s supervision to coordinate a patient’s care across multiple disciplines. In short, 99439 is an add-on CPT code and is usually applied with CPT code 99490 when more time is required.
CPT Code 99489 – Additional Support for Complex Chronic Care (30 Extra Minutes)
This is another popular add-on CPT code for chronic care management. Billing specialists add it with CPT code 99487 if a clinical staff under a healthcare provider’s guidance spends more time planning or managing long-term care of a chronic patient. In short, this CPT code covers each additional 30 minutes that a clinical staff works beyond the first provider-directed hour.
CPT Code 99437 – Additional Physician-Directed Chronic Care (30 Extra Minutes)
This is another add-on CPT code you should be familiar with, especially if you have used the 99491 CCM CPT code. Billing specialists can use it to claim reimbursement for a physician’s extra time – each additional 30 minutes beyond the first half an hour dedicated to creating or managing a personalized care plan.
In simple terms, CPT code 99437 notifies payers that qualified physicians have spent more time on complex cases.
Bottom Line
While living with chronic conditions is a challenge for patients, getting insurance companies to pay for their services is a challenge for healthcare providers. The biggest hurdle? Complex coding requirements! We have disclosed the most common CCM CPT codes so you can avoid coding mistakes that lead to claim denials.
But if you are still struggling with the ever-changing requirements, let a billing company like MediBill MD handle everything. Our CCM billing services also provide access to coding specialists so you can improve your revenue.
