Chronic care management services, first 20 minutes per month
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. 20-minute time requirement not met or documented
Very CommonCCM requires at least 20 minutes of non-face-to-face care management time per calendar month. Claims without documented 20+ minutes are denied.
Common Causes
- • Time log shows <20 minutes of qualifying activities
- • No time documentation provided with claim
- • Activities documented don't qualify as CCM (e.g., routine appointment scheduling)
Resolution Strategy
Provide detailed time log showing 20+ minutes of qualifying non-face-to-face CCM activities (care coordination, medication management, specialist communication, etc.). Time must be documented contemporaneously.
2. Patient doesn't meet 'multiple chronic conditions' requirement
CommonCCM requires patient have 2+ chronic conditions expected to last 12+ months that place patient at significant risk of death, acute exacerbation, or functional decline.
Common Causes
- • Patient has only one chronic condition documented
- • Conditions documented don't meet 'chronic' definition
- • Diagnosis codes don't support CCM criteria
Resolution Strategy
If patient has 2+ qualifying chronic conditions, document them clearly with appropriate ICD-10 codes. If patient doesn't meet criteria, CCM not appropriate.
3. Missing patient consent documentation
CommonCCM requires documented patient consent before billing. Claims without consent on file are denied.
Common Causes
- • Consent form not signed by patient
- • Consent on file but not documented in billing record
- • Verbal consent given but not documented
Resolution Strategy
Obtain and document written patient consent including: 24/7 access to care team, electronic access to health information, patient cost-sharing explained. Maintain consent in medical record.
💬 Plain Language Explanation
What this means
This is chronic care management - ongoing care coordination for patients with multiple chronic conditions. Your doctor's office spent time coordinating your care, managing medications, and communicating with other providers.
Why you might see this
This code is used when your doctor provides ongoing care management for chronic conditions like diabetes, high blood pressure, or heart disease. It covers time spent coordinating your care outside of office visits.
Common context
Used for patients with multiple chronic conditions requiring ongoing care coordination. Can be billed monthly.
What to ask your provider
"'What specific care management services were provided? How much time was spent on care coordination?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
Patient with 2+ chronic conditions requiring at least 20 minutes of non-face-to-face care coordination per month
Common Scenarios
Documentation Requirements
- 2+ chronic conditions documented (expected to last 12+ months)
- Comprehensive care plan shared with patient
- 24/7 access to care team documented
- Electronic care plan accessible to patient
- Time log showing 20+ minutes of qualifying activities
- Patient consent obtained and documented
Coding Guidelines
Bundling Rules
- Cannot bill with transitional care management same month
- Cannot bill with complex CCM (99487) same month
- Requires minimum 20 minutes documented time
Exclusions
- Do not bill in same month as TCM (99495-99496)
- Do not bill in same month as RPM treatment (99457-99458)
- Do not use for patients with only 1 chronic condition
Coding Notes
Medical Necessity: ICD-10
Clinical scenarios
- 2+ chronic conditions documented (expected to last 12+ months)
- Comprehensive care plan shared with patient
- 24/7 access to care team documented
- 2+ chronic conditions documented (expected to last 12+ months)
- Comprehensive care plan shared with patient
- 24/7 access to care team documented
- 2+ chronic conditions documented (expected to last 12+ months)
- Comprehensive care plan shared with patient
- 24/7 access to care team documented
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Frequently Asked Questions
CPT 99490 is the billing code for "Chronic care management services, first 20 minutes per month". Patient with 2+ chronic conditions requiring at least 20 minutes of non-face-to-face care coordination per month
Medicare pays approximately $60.49 for CPT 99490 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 99490 has a total RVU of 1.99, broken down as: Work RVU 0.61, Practice Expense RVU 1.34, and Malpractice RVU 0.04. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 99490 is "20-minute time requirement not met or documented". CCM requires at least 20 minutes of non-face-to-face care management time per calendar month. Claims without documented 20+ minutes are denied. Common causes include: Time log shows <20 minutes of qualifying activities; No time documentation provided with claim. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 99490 include: 2+ chronic conditions documented (expected to last 12+ months); Comprehensive care plan shared with patient; 24/7 access to care team documented; Electronic care plan accessible to patient. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99490: Cannot bill with transitional care management same month. Cannot bill with complex CCM (99487) same month Use an NCCI bundling checker to verify specific code combinations before billing.
The typical time requirement for CPT 99490 is Minimum 20 minutes per calendar month (non-face-to-face). Time-based codes require documentation of the actual time spent providing the service.