In 2017 The Centers for Medicare & Medicaid Services (CMS), acknowledged that there are both non-complex and complex Chronic Care Management services provided to patients. Thus, CMS added two new codes for what they now call Complex CCM Services. Moreover, they included new CPT codes for the initiating visit.
The five new CCM codes are characterized as follows:

CCM (CPT 99490)

  • Clinical Staff Time: 20 minutes or more in qualifying services.
  • Care Planning: established, implemented, revised, or monitored.
  • Billing Practitioner: provides ongoing oversight, direction, and management. Assumes 15 minutes of work

Complex CCM (CPT 99487)

  • Clinical Staff Time: 60 minutes in qualifying services.
  • Care Planning: established or substantially revised
  • Billing Practitioner: provides ongoing oversight, direction, and management, in addition to medical decision-making of moderate-high complexity. Assumes 26 minutes of work

Complex CCM Add-On (CPT 99489, use with 99487)

  • Clinical Staff Time: For each additional 30 minutes of clinical staff time that is required
  • Care Planning: established or substantially revised
  • Billing Practitioner: provides ongoing oversight, direction, and management, in addition to medical decision-making of moderate-high complexity. Assumes 13 minutes of work

CCM Initiating Visit

  • Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), Transitional Care Management (TCM), or other qualifying face-to-face Evaluation and Management (E/M).
  • Billing Practitioner: usual face to face work required by the billing initiating visit code.

Add-on to CCM initiating visit (G0506)

  • Care Planning: established
  • Billing Practitioner: performs extensive assessment and CCM care planning beyond the usual effort described by the separately billable CCM initiating visit.
Resources: Department of Health and Human Services – Centers for Medicare and Medicaid – Medicare Learning Network

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