About Chronic Care

The CMS has identified Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) as crucial components of primary care for patients. This page provides CPT codes and descriptions for billing chronic care management (CCM), remote patient monitoring (RPM) and transitional care management (TCM) services under CPT codes 99487, 99489, 99490 and 99491.

CHRONIC CARE MANAGEMENT (CCM) CPT BILLING CODE

CPT 99490 – $42

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
  • Comprehensive care plan established, implemented, revised, or monitored

G2058 – $38 (new 2020)

Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (limit 2x during service period)

CPT 99487 – $94

Complex chronic care management services, with the following, required elements:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
  • Establishment or substantial revision of a comprehensive care plan
  • Moderate or high complexity medical decision making
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

CPT 99489 – $47

Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

HCPCS G0506 – $64

Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure)

TRANSITIONAL CARE MANAGEMENT (TCM) CPT BILLING CODE

CPT 99495 – $188 (increase for 2020)

Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

CPT 99496 – $248 (increase for 2020)

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)

Principal Care Management (PCM)

G2064 – $92 (new 2020)

Comprehensive care management services for a single high-risk disease, at least 30 minutes of physician or other qualified health care professional time per calendar month.

G2065 – $40 (new 2020)

Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.