Episode Details

Your practice is sitting on money you've already earned but haven't collected. Every month, you're coordinating care for patients with diabetes and hypertension, calling them about medication changes, updating their treatment plans, and keeping them out of the emergency room. You're doing the work. Medicare wants to pay you for it. But somehow, that money never makes it to your bank account because nobody explained how chronic care management billing actually works. Here's what's really happening. You have patients managing two or more chronic conditions that will last at least a year. These conditions put them at serious risk for decline, hospitalization, or worse. When you spend just twenty minutes a month coordinating their care through phone calls, medication reviews, and care plan updates, Medicare pays you over sixty dollars per patient. That's not pocket change. If you're managing fifty eligible patients properly, that's three thousand dollars monthly that most practices never touch. The problem is that CCM billing feels deliberately confusing. You need written patient consent before you start. Your documentation has to live in a certified electronic health record with twenty-four-hour access. You can only bill one practitioner per patient each month, even if your entire team is involved. Get any of this wrong and your claims get denied, or worse, you face an audit that makes you wish you'd never heard of chronic care management. Let's talk about what actually qualifies. Your patients don't need exotic diagnoses. We're talking about the people you see every week with diabetes, high blood pressure, COPD, heart disease, depression, arthritis, or kidney disease. If they're managing multiple conditions that require ongoing attention to prevent serious complications, they qualify. Medicare deliberately leaves the definition broad because they trust your clinical judgment about who needs coordinated care. The consent conversation is where most practices stumble. You need to document exactly what you told the patient, including service availability, their potential costs, how they can revoke consent, and the fact that only one provider can bill for them monthly. This isn't a quick mention during a busy visit. This is a real conversation with real documentation that protects you when audits happen. Now for the codes that actually matter. When your clinical staff provides that first twenty minutes of care coordination under your supervision, you're billing 99490. This covers care planning, medication management, and coordinating with specialists. If the patient needs more than twenty minutes that month because things got complicated, you bill 99439 for each additional twenty-minute block, up to twice monthly. That's sixty total minutes when patients genuinely need extra support. When you personally spend at least thirty minutes on complex care coordination instead of delegating to staff, you're billing 99491, which pays more because it recognizes your higher-level clinical expertise. Each additional thirty minutes gets coded as 99437. The difference between staff time and provider time matters significantly in reimbursement, so document who's actually doing the work. For your truly complex patients who need sixty minutes or more monthly, code 99487 reflects that intensive coordination. We're talking about patients with multiple interacting conditions, frequent medication changes, behavioral health needs, or complicated social situations. This pays around one hundred thirty dollars because keeping these patients stable takes real effort. Each additional thirty minutes beyond the initial sixty gets billed separately with 99489, and there's no monthly limit when the medical necessity is documented. Here's the documentation trap that catches everyone. Medicare auditors are looking for specific dates, exact minutes spent, staff names, and detailed descriptions of what you actually did. Rounded estimates raise red flags immediately