Medicare reimburses practices for chronic care management, but billing requirements trip up most implementations. Understanding CPT codes, time tracking, documentation standards, and compliance rules helps practices capture revenue they’re already earning through patient care.
Your practice probably already does chronic care management by calling patients between visits, coordinating with specialists, reviewing medications, and answering questions about diabetes or hypertension management. The problem is you're not getting paid for any of it.
Medicare created Chronic Care Management codes specifically to reimburse this work, yet most practices either don't bill for CCM at all, or they set up programs that immediately run into compliance problems. The difference between success and failure usually comes down to understanding the billing requirements before you start.
The appeal is obvious since Medicare pays for care coordination that you're likely already providing. But here's where practices get stuck: they buy expensive software, assign it to staff, and expect revenue to flow automatically when it doesn't work that way.
"CCM billing has rigid requirements, and Medicare audits these claims regularly," says CCM RPM Help, a consulting company specializing in care coordination program implementation. "If your documentation doesn't meet their standards, you'll face denials, payback demands, or worse. The complexity scares many practices away from programs that could add significant recurring revenue."
The company explains that three problems derail most implementations:
Missing the workflow step. Software can't fix broken processes, so you need clear protocols for which staff members handle which tasks, how you'll track time, and where documentation lives. Without these systems in place first, your team will struggle to bill correctly even with the best technology.
Misunderstanding consent requirements. Patients must give written consent before you can bill CCM services, and that consent must be documented in specific ways. Many practices collect verbal agreement or use non-compliant forms, then wonder why claims get rejected.
Inadequate time tracking. Medicare requires precise documentation of every minute spent on CCM activities, meaning "we probably spent 20 minutes" doesn't count. You need contemporaneous notes showing exactly what you did and how long it took.
CCM reimbursement follows a tiered structure based on time and complexity, and understanding these tiers helps you capture appropriate payment for the work you're doing.
This is your starting point where you bill 99490 when you provide at least 20 minutes of non-face-to-face care coordination in a calendar month. The 2025 Medicare reimbursement sits around $42 for this code, though rates vary by geographic adjustment.
What counts toward those 20 minutes includes phone calls with patients about medication changes, time spent reviewing lab results and adjusting treatment plans, coordination calls with specialists, and documentation of all these activities. Time spent during face-to-face visits doesn't count.
You can only bill one patient once per month for basic CCM, and the clock resets on the first of each month. If you spend 15 minutes in January and 25 minutes in February, you can bill February but not January.
When care coordination needs exceed 20 minutes, you can bill additional time since code 99439 covers each additional 20 minutes beyond the first increment. If you spend 45 minutes on CCM activities in one month, you bill both 99490 and 99439.
This is where practices leave significant money on the table because patients with multiple chronic conditions often require this level of coordination. You're doing the work; you just need to document it properly to get paid.
Some patients need more intensive management where code 99487 requires at least 60 minutes of care coordination monthly. Medicare pays approximately $95 for this service when the patient has multiple chronic conditions with high risk of hospitalization or functional decline.
This code requires a written care plan that's more detailed than basic CCM, meaning you must document specific treatment goals, medication reconciliation, and coordination with all treating providers. The administrative lift is heavier, but so is the reimbursement.
Medicare wants proof you did what you're billing for, so your documentation must include specific elements or the claim will be denied.
Before you bill anything, verify the patient meets CCM criteria by having two or more chronic conditions expected to last at least 12 months, and those conditions must place them at significant risk of death, acute deterioration, or functional decline.
You need written consent that explains what CCM services include, how often the patient can expect contact, and that cost-sharing may apply. The consent form must state clearly that only one practitioner can bill CCM for this patient per month, and you should keep signed consents in the patient record for audit protection.
Medicare requires a written care plan for every patient receiving CCM services, and this isn't a template you fill out once and forget. The plan must be patient-specific and include:
Update this plan whenever the patient's condition changes, and document that you shared the plan with the patient and any relevant caregivers.
This is where practices often fail audits since you must document each CCM activity with the date, duration, staff member involved, and description of the service provided. "Patient call - 5 minutes" isn't sufficient when you need "Discussed medication side effects and reviewed blood pressure log. Adjusted timing of evening dose. Duration: 8 minutes."
Track time in real-time or immediately after the activity because reconstructing time logs weeks later creates documentation that looks suspicious during audits. Medicare can request these records up to seven years after you submit a claim.
Smart practices work backward from billing requirements when designing CCM programs by building workflows that generate compliant documentation automatically, rather than trying to retrofit compliance onto existing processes.
Start by mapping your current care coordination activities to identify which staff members already call patients about medications, who coordinates specialist referrals, and where this information gets documented now. You're looking for work that's already happening but not being captured for billing purposes.
Next, create standardized protocols for CCM activities by defining which conditions qualify patients for enrollment, establishing who makes initial contact to explain the program and obtain consent, and deciding how you'll track time and where documentation will live. These protocols should integrate with your existing EHR rather than requiring separate systems.
Train your team on documentation standards before you bill your first claim, since everyone involved in CCM activities needs to understand what Medicare requires. Run practice scenarios where staff document mock patient interactions, then review those practice logs and correct any issues before you're dealing with real claims.
Choose technology that supports your workflows rather than dictating them, meaning the right software should make time tracking and documentation easier, not add administrative burden. Look for systems that integrate with your EHR and generate audit-ready reports automatically.
Healthcare organizations that run successful CCM programs share common characteristics: they prioritized compliance from day one, invested in staff training before chasing revenue, and treated program implementation as a workflow project, not a technology purchase.
Consulting experts in this field emphasize that doing good patient care and doing well financially aren't separate goals. When you provide consistent follow-up and education between office visits, patients stay healthier, and when you document that care correctly, Medicare reimburses you fairly for the work. The challenge is building systems that make both outcomes sustainable.
These experts help practices avoid the expensive mistakes that come from rushing implementation by guiding teams through workflow design, ensuring documentation meets audit standards, and establishing time-tracking processes that staff actually use. The initial investment in getting the setup right pays for itself by preventing claim denials and compliance problems down the road.
CCM programs work when you build them on a foundation of clear processes and compliant documentation, though the billing requirements aren't insurmountable, but do demand attention to detail and systematic execution.
Start by auditing what you're already doing through listing the care coordination activities your practice handles routinely and calculating roughly how much time you spend monthly on these tasks per patient. That analysis will show you how much potential revenue you're currently leaving unclaimed.
Then focus on the workflow and compliance infrastructure before you worry about technology by getting your consent process right, establishing documentation standards, and training your team. The practices that succeed with CCM treat implementation as a serious operational initiative, not a side project for one staff member to handle when they have spare time.
If you're ready to explore how to set up a Medicare-compliant CCM program for your practice, talking with specialists who focus on implementation can save you months of trial and error.
Medicare uses several codes depending on service complexity and time spent, where CPT 99490 covers basic CCM requiring 20 minutes monthly. Code 99439 bills additional 20-minute increments beyond the first, and CPT 99487 applies to complex cases requiring 60+ minutes. Each code has specific documentation requirements and different reimbursement rates that vary by region.
You must document time contemporaneously using detailed activity logs that record each interaction's date, duration, staff member, and specific services provided. Include phone calls, care plan updates, specialist coordination, and medication reviews while avoiding vague entries like "patient contact." Medicare auditors look for precise descriptions that justify the time claimed, and most successful practices use integrated EHR tools that timestamp activities automatically.
No, since only one practitioner can bill CCM services for a patient in any given calendar month under the "one provider per patient per month" rule. If multiple providers see the patient, they must coordinate who will bill CCM, and the patient's consent form should clearly identify which practice will provide and bill for care management services.
Specialized consulting services exist specifically to help healthcare organizations build Medicare-compliant CCM and RPM programs. These consultants handle workflow design, staff training, EHR integration, and documentation protocols. Working with implementation experts helps practices avoid the costly mistakes that lead to claim denials or audit problems.
