What Chronic Care Management CPT Codes Do for Medical Billing

by  Find-A-Code™
Aug 11th, 2023

Common Procedural Terminology (CPT) codes were developed by the American Medical Association (AMA) in the 1960s as a way to streamline medical billing by standardizing the codes healthcare providers used for billing purposes. In the more than 50 years since, the CPT code set has undergone a litany of changes including the introduction of CPT codes for chronic care management (CCM).

The CCM codes provide a different way for clinicians and healthcare facilities to bill for treating chronic conditions as opposed to their acute counterparts. Why is the distinction necessary? Because healthcare providers are now managing chronic conditions among an estimated 60% of the population. Management of a chronic condition requires more work than simply treating a single condition affecting that patient.

Chronic condition management is a completely different exercise than the typical medical decision making encounter. Unlike one-off treatments in a GP's office, chronic conditions require ongoing monitoring and maintenance. They require regular visits, evaluations, and tests. As such, clinicians need to be compensated for the higher level of care they provide.

Codes That Distinguish Chronic Care

Introduction of the CCM CPT codes instantly gave healthcare providers a way to distinguish chronic care from acute treatments. Subsequently, creating the distinction also allowed providers to negotiate higher reimbursement rates for such services. Prior to getting the codes, services were often being billed at a lower rate.

The CCM codes facilitate more accurate billing. They also offer a systemic approach for integrating chronic care management with the rest of a patient's healthcare needs, subsequently leading to better outcomes.

The Big 6 CCM CPT Codes

The good news for medical coders and billers is that the CCM CPT codes are limited. There are only six that pertain to most situations. As long as a coder or biller understands that a patient has been treated for a chronic condition, looking up and applying the right code is pretty straightforward.

Here are the big 6 CCM CPT codes:

• 99490 – Pertains to 20 minutes per month of chronic care management services that are not provided in a face-to-face setting. Creating a managed care plan is a good example.
• 99487 – Pertains to 60 minutes per month of chronic care management services not provided in a face-to-face setting, usually for patients with multiple chronic conditions.
• 99489 – Pertains to an additional 30 minutes of services in conjunction with the initial 60 minutes billed under CPT 99487.
• 99439 – Pertains to 20 minutes of chronic care management services that are provided face-to-face by clinical staff.
• 99491 – Pertains to 30 minutes of initial chronic care management services provided by a physician or non-physician practitioner (NPP) in a face-to-face setting.
• 99492 – Pertains to 30 minutes of additional face-to-face services in conjunction with the initial 30 minutes billed under CPT 99491.

Designating between multiple and single chronic conditions is required and providers need to document even greater detail. Some patients seek care for just one chronic condition while others are battling multiple conditions simultaneously. There can be significant differences in how managed care is provided based on this one aspect alone.

Accurate Codes Are Key to Correct Bills

Although there are only six CCM CPT codes most coders and billers need to worry about, it is still important that they familiarize themselves with each one. It goes without saying that accurate codes are the key to correct billing. Maintaining familiarity is just one aspect of generating accurate bills.

As for CPT codes in general, they continue to change and evolve over time. With every new edition comes an effort to maintain a code set that keeps pace with changes to medical procedures. There are always changes afoot, meaning life is never dull for medical coders or billers.