New Rules for Medicare Payments for Chronic Care Management Services

Streamlined payment rules and more billing options make it easier to get reimbursed

March 2017 

In 2015, the Centers for Medicare and Medicaid Services (CMS) began paying separately for non-face-to-face care coordination services provided to Medicare beneficiaries with multiple chronic conditions. CMS reimbursed practitioners approximately $43 per patient per month for 20 minutes of care management services billed under AMA CPT code 99490.¹

The new reimbursement was intended to support the efforts of physicians who know that care coordination services are an important component of quality patient care.

Unfortunately the administrative requirements associated with proper use of the chronic care management (CCM) code were cumbersome and likely dissuaded many practices from even bothering to take advantage of the reimbursement opportunity.

Effective Jan.1, 2017, CMS has taken important steps to simplify the billing requirements for chronic care management services, and has also begun reimbursing for two additional codes that reflect care provided for more “complex” services (CPT codes 99487 and 99489).

The key differences between regular CCM services (i.e., CPT code 99490) and complex CCM services (i.e., CPT codes 99487 and 99489) are the amount of clinical time spent providing the services and the extent of care planning, as well as the complexity of the problems being addressed by the physicians or other health care professionals. Required service elements are the same for both regular and complex CCM services.

CMS has established specific guidelines for payment for CPT codes 99490, 99487 and 99489, and practices need to be sure they are meeting all the necessary requirements in order to appropriately bill for these services.

Note: This Issue Brief is intended to be a general summary highlighting key features of the new chronic care management (CCM) codes and billing requirements. Physicians are strongly encouraged to review the resources CMS developed for billing Medicare for CCM services. Links to additional resources are at the end of this document.

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