CCM Billing: A Step-by-Step Guide for Your Billing Team

For CCM billing, work through seven checks before submitting the claim. If consent or another payment requirement is missing, the practice can bill neither Medicare nor the patient (CMS CCM FAQ).

These steps cover 99490 and 99439 billed under the Physician Fee Schedule; rural health clinics and federally qualified health centers are outside this guide. The practitioner-time and complex codes, 99491, 99437, 99487 and 99489, are not part of Companian’s service; CPT 99490 and 99439 explained covers them. Florida claims go to First Coast Medicare, the A/B contractor for Jurisdiction N.

The CCM billing checklist for each patient and month

Step	Who does it	When	Record kept
1. Practitioner	Billing practitioner	Before outreach	Practitioner named; patient asked about other CCM
2. Initiating visit	Billing practitioner	Before CCM starts, for new patients or those not seen in a year	Visit date; note that discusses CCM
3. Consent	The practice, or a team calling for it	Before the first CCM minute	Consent note: four disclosures, the patient’s answer, date
4. Care plan and time	Clinical staff, billing practitioner	Care plan before the first claim; time as each activity happens	Care plan date; date, minutes, activity, author
5. Other codes	Billing lead	Before each claim	Every care-management code billed that month
6. Units	Billing lead	Before each claim	Total minutes; units, with 99439 capped at two (CGS)
7. Claim	Billing lead	On or after the threshold date	Date of service; practice address and ZIP

CCM billing guidelines: who bills, who qualifies, who does the time

• The billing practitioner, a physician, nurse practitioner, physician assistant, clinical nurse specialist or certified nurse-midwife (MLN909188), directs the care, and the practice bills for it.
• The patient has two or more chronic conditions, expected to last 12 months or until death, that put them at significant risk of death, acute exacerbation or decompensation, or functional decline (CY2022 final rule), and the record shows it. Which diagnoses meet that test is set out in what conditions qualify for chronic care management.
• Clinical staff, under the CY2026 rules, furnish the time under general supervision (MLN909188) and may be outside staff if every incident-to and CCM billing rule is met; with little oversight by the billing practitioner, or no clinical integration with the outside team, CMS says the practitioner should not bill CCM (CMS CCM FAQ).

How to bill for chronic care management, step by step

Step 1: Confirm one billing practitioner

Rule: only one practitioner can bill CCM for a patient in a calendar month (MLN909188). Do: name the practitioner in the record and ask the patient whether another practice already provides CCM.

Step 2: Hold the initiating visit when required

Rule: a new patient, or one the billing practitioner has not seen within the previous year, needs an initiating visit first: a comprehensive face-to-face E/M visit, an annual wellness visit or an initial preventive physical exam, billed separately (MLN909188). E/M levels 2 to 5 (99212 to 99215) count as comprehensive (CMS CCM FAQ). Do: check the last visit date before outreach and keep the visit note.

Step 3: Document consent before CCM starts

Rule: the patient is told that CCM is available, that cost sharing may apply, that only one practitioner bills it per month, and that they may stop at any time, effective at month end; written or verbal consent goes in the record (MLN909188). It is obtained once, again only if the billing practitioner changes (CMS CCM FAQ). Do: check the consent date precedes the first CCM minute in the log, and that the note records the four disclosures and whether the patient accepted or declined.

Step 4: Confirm the care plan, then log the time as it happens

Before billing, confirm the care plan and the month’s CCM scope of service (CY2022 final rule; MLN909188; CMS CCM FAQ):

• Keep a current comprehensive care plan on record.
• Maintain structured records in certified EHR technology.
• Provide access to a practitioner or clinical staff 24 hours a day, 7 days a week for urgent needs.
• Name a designated care team member.
• Log eligible time as it happens: date, minutes, activity and author. Only time spent directly by clinical staff or the billing practitioner counts.

CMS expects every scope element each month unless not medically indicated. Use CCM documentation requirements to check the record.

Step 5: Check the month’s other codes

Rule: time counted toward another billed code cannot count toward CCM, and some codes cannot share the month at all (MLN909188). Do: pull every care-management code billed for the patient that month and run it against the table below.

Step 6: Count the units

Count eligible minutes from the monthly log (CY2022 final rule; CMS CCM FAQ).

Eligible minutes this calendar month	Claim
Under 20	No 99490; no carryover
20 to 39	99490
40 to 59	99490 + one 99439
60 or more	99490 + two 99439 (CGS cap)

Step 7: Set the date of service and submit

The threshold date may be the date of service; you do not have to wait for month end (CMS CCM FAQ). Before submitting:

• Use the practice address and ZIP code where the service was furnished; they determine the payment locality (Claims Processing Manual, chapter 26).
• If another 99439 unit may follow, choose whether to submit now or after month end. Ask your MAC how to submit a later unit.

CCM concurrent billing: which codes can share the month

Same patient, same month	Same practitioner	Different practitioner	CMS source
99490 or 99439 with 99491, 99437, 99487 or 99489 (not part of Companian’s service)	Not allowed	Not allowed	MLN909188; CCM FAQ
CCM with PCM (99426, 99427)	Not allowed	Allowed for different conditions, two care plans	CCM FAQ; CY2020 rule
CCM with PIN (G0023, G0024) or CHI (G0019, G0022)	Allowed if time and effort count once, each service’s rules are met and both are reasonable and necessary	Same terms	HRSN FAQ; CY2024 rule
CCM with TCM (99495, 99496)	Allowed when medically necessary; TCM minutes cannot count toward CCM	Same terms	MLN909188; CCM FAQ
CCM with APCM (G0556 to G0558)	Not allowed	Allowed when medically necessary, including a practitioner in the same practice	CY2025 rule
CCM with remote physiologic or therapeutic monitoring, one of the two	Allowed if no time is counted twice	Same terms	MLN909188; CY2024 rule
CCM with behavioral health integration	Allowed, with separate consent; no time counted twice	Allowed	CY2017 rule
CCM with G0181, G0182 or 90951 to 90970	Not allowed	Not stated by practitioner; confirm with your MAC	MLN909188

For principal illness navigation and community health integration billed together by one practitioner, confirm with your MAC before you bill.

Common CCM billing errors that make a month unbillable

How does CCM billing differ between Original Medicare and Medicare Advantage?

Coverage	Payment and cost-sharing check
Original Medicare	The claim steps above apply. Usual Part B deductible and coinsurance apply.
Medicare Advantage: contract provider	Payment follows the practice’s contract. Check the plan contract for prior authorization and cost sharing.
Medicare Advantage: non-contract provider	Accept as payment in full what the practice could collect under Original Medicare. Check the plan’s terms before enrollment.

Running chronic care management without adding staff

If staff time is the bottleneck, a chronic care management company can take on the day-to-day program work while the billing practitioner directs the care and the practice bills. The guide to outsourcing CCM compares the three ways to staff it.

With Companian: Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license. Which team members’ time counts toward each code is set in your services agreement, within the CMS rule that only clinical staff or billing-practitioner time counts (MLN909188).

Key takeaways

• 99490 requires two or more qualifying chronic conditions and a comprehensive care plan; without the plan the month is not billable.
• Consent comes before the first CCM minute, not just before the claim.
• Confirm the two-unit 99439 cap with your own MAC.
• PCM shares the month only from a different practitioner, for a different condition; G0181, G0182 or 90951 to 90970 block CCM for the month.
• Medicare Advantage pays a contract provider under its contract and a non-contract provider the Original Medicare amount.

Questions about CCM claims

Can you bill CCM for a patient with one chronic condition?

No. 99490 requires two or more qualifying chronic conditions. A patient with one high-risk chronic condition may fit principal care management instead, under its own codes and rules.

Does CCM require a face-to-face visit every month?

No. The only face-to-face requirement is the initiating visit, before CCM starts, for a new patient or one the billing practitioner has not seen within the previous year (MLN909188).

Can unused CCM minutes carry over to the next month?

No. The service period is one calendar month, so a month below 20 minutes is not billed and its minutes do not move forward.

What activities count toward CCM time?

Time clinical staff or the billing practitioner spend directly on the patient’s CCM: assessing needs, reviewing medications, coordinating with specialists and home- and community-based providers, following up after an emergency visit or discharge, and revising the care plan (MLN909188). Time counted toward another billed code does not count.

Can you bill CCM for the month a patient opts out?

Yes, if that month meets the time threshold and every other requirement, because the stop takes effect at the end of the calendar month. Nothing is billed for the months after it.

Does consent have to be obtained at the initiating visit?

No. CMS treats the initiating visit and consent as separate requirements, and consent does not have to be obtained during the visit (CMS CCM FAQ). It must still be documented before CCM starts.

Chronic care management (CCM) is a Medicare Part B service billed monthly by physician practices under codes including CPT 99490 and 99439; principal care management, principal illness navigation and community health integration are separate services in the same care management family. For CCM, Companian works with practices this way: your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Sources

1. CMS, Chronic Care Management Services (MLN909188), June 2025
2. CMS, CCM Practitioner Billing FAQs, August 2022
3. CY 2022 Physician Fee Schedule final rule (86 FR 64996)
4. CGS Administrators, Chronic Care Management (CCM), February 2022
5. CY 2020 Physician Fee Schedule final rule (84 FR 62568)
6. CY 2024 Physician Fee Schedule final rule (88 FR 78818)
7. CMS, Health-Related Social Needs FAQs (CHI and PIN), March 2026
8. CY 2025 Physician Fee Schedule final rule (89 FR 97710)
9. CY 2017 Physician Fee Schedule final rule (81 FR 80170)
10. CMS, Medicare Claims Processing Manual, Chapter 26
11. 42 CFR 422.214, noncontract providers
12. CMS, MLN Matters MM14279, 2026 Part B amounts

Read more: APCM vs CCM vs PCM: which program fits · How the referral and billing split works for physicians