CCM

Chronic Care Management

Structured monthly care coordination for Medicare patients with two or more chronic conditions. The foundation of care management that delivers predictable revenue and better patient outcomes.

What is Chronic Care Management?

Chronic Care Management (CCM) is a Medicare program that reimburses healthcare providers for non-face-to-face care coordination services for patients with multiple chronic conditions. Introduced by CMS in 2015, CCM recognizes that managing chronic diseases requires ongoing attention between office visits.

For independent practices, CCM represents a significant revenue opportunity while improving patient outcomes. When delivered effectively, CCM reduces hospitalizations, improves medication adherence, and helps patients better manage their conditions between visits.

Revenue opportunity: A practice with 500 Medicare patients can typically identify 150–200 CCM-eligible patients, generating $50,000–$100,000+ in additional annual revenue when the program is fully implemented.

CCM Eligibility Requirements

To qualify for CCM services, patients must meet the following criteria:

Two or more chronic conditions: Conditions expected to last at least 12 months, or until death of the patient
Significant risk: Conditions place the patient at significant risk of death, acute exacerbation, or functional decline
Medicare beneficiary: Patient must be enrolled in Medicare Part B
Patient consent: Written or verbal consent must be documented

Common Qualifying Conditions

Hypertension
Diabetes
Heart Failure
COPD
Chronic Kidney Disease
Arthritis
Depression
Atrial Fibrillation

CCM Service Components

A comprehensive CCM program includes the following elements, all of which CareStream manages on behalf of your practice:

  • Comprehensive care plan: Development and ongoing updates to a patient-centered care plan addressing all chronic conditions
  • Monthly care coordination: Regular non-face-to-face management including phone calls, medication reviews, and care coordination
  • Medication management: Reconciliation, adherence monitoring, and coordination with pharmacies
  • 24/7 access: Patients must have access to care team or on-call provider 24/7
  • Care transitions: Coordination during hospital admissions, discharges, and specialist referrals
  • Documentation: Detailed records of all care management activities and time spent

CCM Billing Codes

CCM services are billed using the following CPT codes based on time spent and complexity:

CPT CodeDescription
CPT 99490First 20 minutes of clinical staff time per calendar month
CPT 99439Each additional 20 minutes of clinical staff time
CPT 99491First 30 minutes of physician/QHP time per calendar month
CPT 99437Each additional 30 minutes of physician/QHP time

How CareStream Delivers CCM

CareStream operates CCM as a fully managed service. Our team handles the operational complexity while your practice maintains clinical oversight:

01

Patient Identification

Automated analysis of your EHR data to identify eligible patients.

02

Enrollment

Compliant consent collection through phone, SMS, or in-practice workflows.

03

Care Plan Development

Comprehensive care plans aligned with patient goals and conditions.

04

Monthly Engagement

AI-assisted patient outreach and monitoring with regular check-ins.

05

Time Tracking

Automated documentation of all billable activities, with no manual logs.

06

Escalation

Intelligent routing of clinical issues to your care team when needed.

07

Billing Support

Compliant claim generation with audit-ready documentation.

CCM vs. APCM: Which is Right for Your Practice?

While CCM has been the standard for care management billing, APCM offers a simplified alternative for many practices. Consider CCM if:

  • Your practice has existing CCM workflows and documentation processes
  • You have staff familiar with time-based billing requirements
  • Your patient population may benefit from the specific CCM service requirements

Consider APCM if you want simplified billing without time tracking requirements. Many practices are transitioning to APCM for its reduced administrative burden. Learn more about APCM →

Related Programs

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We handle the complexity so your practice can generate predictable monthly Medicare revenue.

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