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News & Press: General Announcement

New Medicare Billing Codes for Chronic Care Management

Monday, May 14, 2018   (0 Comments)
Posted by: ACOFP
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View the full CMS Resource Guide to Chronic Care Management Here


From the ACOFP


CMS has developed a program called Chronic Care Management (CCM) for Medicare Part B patients enrolled in either Traditional Medicare or Medicare Advantage. For either program, the physician needs to have the patient sign a patient consent form.


CCM allows for additional billing for care coordination time:

  • By identifying Medicare or dual eligible patients, who have two or more chronic conditions that will last longer than 12 months, or until death, and enrolling them in Medicare’s Chronic Care Management program, CMS will reimburse the physician for additional care coordination time spent with them between monthly appointments.

  • Telehealth is now included and can be used for the 20-minute touch point code (see below).

  • Nearly two-thirds of Medicare patients have two or more chronic conditions, who would qualify for the CCM program. Physicians are encouraged to consider the opportunity this brings their patients and practice.

There are four new CCM codes that were added in 2018. These ensure that the eligible clinician can bill for additional time spent with the patient. Eligible clinicians (EC) include: Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants and Certified Nurse Midwives. Only one person may bill for the appropriate CCM codes per month.

  • CPT 99490 is billable for 20 minutes of clinical staff time per calendar month, spent on activities to manage care for CCM patients. This payment is $42.00.

  • CPT 99487 is for complex CCM activity, such as revision of a care plan, moderate or high complexity medical decision-making, for 60 minutes of staff time.

  • CPT 99489 is an add-on code for 99487 for each additional 30 minutes of clinical staff time.

  • HCPCS G0506 is an add-on code to the CCM initiating visit code for comprehensive care planning outside the usual effort.

CCM may be a new way for practices to implement value-based care, resulting in better quality outcomes, reduced costs and improved patient satisfaction.

For 2018, the CMS Quality Payment Program pays a five to 15 percent incentive to those who meet benchmarks of Quality, Resource Use, Advancing Care Information and Practice Improvement Activities. Learn more >>

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