With old age come many health problems that can’t usually be avoided. The top 10 chronic conditions that patients covered by Medicare suffer from are: high blood pressure, high cholesterol, arthritis, diabetes, heart disease, kidney disease, depression, heart failure, emphysema, Alzheimer’s/Dementia. Any patient suffering from two or more such conditions is eligible to receive healthcare services covered by the Medicare CCM (Chronic Care Management).

The Chronic Care Management system comes with many advantages both for patients and healthcare professionals:

  • The patients of your practice gain a dedicated team that helps them stay on the right track in terms of health. This improves patient care coordination and connectivity between physician and patients.
  • Patients affected by chronic conditions are treated based on a comprehensive plan, which may include reaching certain health goals in a given time frame. Such goals can be physical (e.g. lowering cholesterol), mental (e.g. improved state of mind) or functional (e.g. being able to walk longer routes).
  • Patient support between visits. The CCM program can encourage patients to stick to the health plan and be pro-active. While medical visits can be few and far between, the chronic conditions need constant supervision and support, to avoid the risk of falling off the right track. Sometimes, this can include some much needed motivation to comply to the treatment plan or simple reminders to take your medicine.
  • Structured recording of the patient health information
  • Improved patient satisfaction and compliance
  • Improved care coordination
  • Increased revenue for healthcare providers, who receive payment specifically for applying the provisions of the CCM program


CCM has multiple billable codes that are paid by most insurances.

  • CPT 99490 – requires a minimum of 20 minutes / month of clinical staff time dedicated to a patient with chronic conditions. A comprehensive care plan must be established, implemented, revised or monitored
  • CPT 99491 – requires a minimum of 30 minutes / month of direct provider time dedicated to a patient with chronic conditions
  • CPT 99487 – complex CCM – the same conditions as above apply, with the addition that this type of treatment involves a moderate or high complexity medical decision making process. 60 minutes / month of clinical staff time is required
  • CPT 99489 – each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month


Click the Get Started button above to learn how Medistics can help you serve your patients and provide CCM services to them!


Profit Calculator Assumptions: 40% of total Medicare patients enrolling is based on (i) Medicare Chart Book’s data showing that ~68% of medicare patients qualify for CCM (2 or more chronic conditions), and (ii) that ~40% of eligible patients will enroll.

For typical providers, $46.67 of net profit per patient per month is based on a Medicare reimbursement per patient per month (national average) for various care management CPT codes.

CPT and other codes, descriptions and other data are copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).