Care Management Services Overview

This series of articles will discuss the various types of Care Management Services. This page serves as an anchor for seven upcoming articles.

(CCM) Chronic Care Management Services

  • 99490: At least 20 minutes of clinical staff time per month (approx. $64)
  • +99439: Each additional 20 minutes of clinical staff time (approx. $48)
  • 99491: At least 30 minutes of care by a physician or other qualified healthcare professional per month (approx. $86.70)
  • +99437: Each additional 30 minutes of care by a physician or other qualified healthcare professional (approx. $61.08)

(CCCM) Complex Chronic Care Management Services

  • 99487: Complex Chronic Care Management services; first 60 minutes of clinical staff time directed by a physician or OQHP, per calendar month (Novitas $136.84)
  • +99489: …; Each additional 30 minutes of staff clinical staff time (Novitas $73.76)

(PCM) Principal Care Management

  • 99424: First 30 minutes of care management by a physician or qualified healthcare professional (Novitas $84.82)
  • +99425: Each additional 30 minutes of care management (Novitas $61.41)
  • 99426: First 30 minutes of clinical staff time, directed by a physician or qualified healthcare professional (Novitas $63.55)
  • +99427: Each additional 30 minutes of clinical staff time (Novitas $48.35)

(TCM) Transitional Care Management

  • 99495: Transitional Care Management – Moderate MDM ($210.79)
  • 99496: Transitional Care Management – High MDM ($285.09)

(ACM) Advance Care Management

  • 99497:  Advance Care Planning (ACP) services ($84.03)
    • Used for the first 16 to 30 minutes of ACP services
  • +99498:  …; Each additional 30 minutes of ACP services ($72.98)

ACP services can be billed multiple times for a patient in a given time period, as long as the patient’s health status or end-of-life care wishes change.

Advance Primary Care Management (CPT codes coming in 2025)

Resource:  MSHBC APCM Article

Psychiatric Collaborative Care Management and BHI Services

  • 99492–99494: Psychiatric collaborative care management ($155.89) ($142.87) ($60.41)
  • 99484: General behavioral health integration ($56.24)

Series Part I: Chronic Care Management Services

Resources:

Behavioral Health Integration

Behavioral Health Integration Services Booklet (PDF)
Behavioral Health Integration FAQs (PDF)