99490

Chronic Care Management (CCM), 20 minutes or more

Chronic Care Management (CCM) services for patients with multiple (2 or more) chronic conditions expected to last at least 12 months, or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. This code represents at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, for non-face-to-face care coordination.

Clinical Indications

  • Patients with two or more chronic conditions (e.g., hypertension, diabetes, heart failure, COPD, arthritis, depression)
  • Conditions expected to last at least 12 months or until the death of the patient
  • Conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
  • Patient consent for CCM services has been obtained and documented
  • Comprehensive care plan established, implemented, and monitored

Procedure Steps

  1. Obtain and document patient consent for chronic care management services.
  2. Establish, revise, or monitor a comprehensive care plan, including a problem list, expected outcomes, prognosis, and planned interventions.
  3. Provide 24/7 access to care management services, including an urgent care contact.
  4. Perform medication reconciliation with review of all prescribed and over-the-counter medications.
  5. Facilitate transitions of care (e.g., from hospital to home, between care settings and providers).
  6. Coordinate care with home health agencies, other specialists, and community resources.
  7. Educate the patient and/or caregiver on self-management of chronic conditions.
  8. Spend a minimum of 20 minutes of clinical staff time per calendar month on non-face-to-face care management activities.
  9. Document all care management activities, including time spent and updates to the care plan.

Coding Guidelines

  • Requires at least two chronic conditions that are expected to last at least 12 months or until death.
  • The chronic conditions must place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
  • Patient consent for CCM services must be obtained and documented prior to the initial billing.
  • A comprehensive care plan must be established, implemented, and monitored.
  • A minimum of 20 minutes of clinical staff time directed by a physician or other qualified health care professional must be spent on non-face-to-face care coordination services per calendar month.
  • Only one practitioner can bill for CCM services for a given patient in a calendar month.
  • CCM cannot be billed in the same month as certain other codes, such as Transitional Care Management (99495, 99496), Home Health Care Plan Oversight (G0181), Hospice Care Plan Oversight (G0182), or certain End-Stage Renal Disease (ESRD) services.
  • Services must be non-face-to-face; face-to-face encounters are separately billable (e.g., E/M visits).
  • Comprehensive documentation of all care management activities, including time spent, is essential for auditing purposes.

Associated ICD-10 Codes