What changes did Medicare make to the CPT codes for Chronic Care Management for 2021?

The short answer is not very much. In the 2021 Final Rule from CMS, the only substantive change was that the stopgap code G2058 was deleted and replaced with code 99439. The descriptor for 99439 is also identical to the descriptor for G2058. This was and still is the 20 minute add-on code for Basic Chronic Care Management services. Apart from this minor change, the chronic care management program was virtually untouched by the 2021 Final Rule from CMS. As in 2020, there are three main CPT codes and two add-on CPT codes in 2021 that may be billed by primary care providers for CCM services.

2023 Medicare CPT Code Reimbursements for Chronic Care Management

How did Medicare Reimbursements for Chronic Care Management Change for 2023?

With each new year, the Centers for Medicare and Medicaid Services (CMS) issues updates to the reimbursement rates for all CPT codes, including those for chronic care management (CCM).

2023 updates to the Final Rule went into effect on January 1, 2023 and will impact how clinical practitioners can bill for the services they provide.¹ And while the Final Rule impacts reimbursements for all billable Medicare services, we are only going to break down the changes related to CCM.

Unlike in the 2022 Final Rule, where CMS increased CCM reimbursement rates by as much as 50% in some cases, for 2023 CMS made no substantive changes to the reimbursement rates corresponding to the CPT codes for CCM. However, CCM reimbursements were still modestly impacted by updates CMS made to the Relative Value Unit (RVU) Multiplier, as explained in more detail below.

The CCM CPT Code Reimbursement Rates for 2023

One factor used by CMS to calculate reimbursement rates is the Relative Value Unit (RVU) Multiplier, a conversion factor that determines how much clinical staff can bill for the services they provide via CPT codes.²

The RVU Multiplier for 2023 reimbursement rates is $33.89, a slight decrease from $34.61 in 2022, but also a bit higher than the $33.06 that was originally proposed. Across the board, this resulted in a modest decrease to CCM reimbursement rates, generally less than 3% in most cases. While the impact of the decrease to the RVU Multiplier may be more significant for other CPT Codes, CCM reimbursements are still buoyed by the fact that rates were significantly increased in 2022.³

Below are the 2023 CPT codes for basic CCM, including their corresponding description and average reimbursement:

2023 CCM Reimbursement Rates
CPT Code	Time Spent By Clinical Staff	Reimbursement
BASIC CCM
99490	at least 20 minutes delivering care to a patient per calendar month.	$62*
99439	Additional 20 minutes per calendar month providing care, up to two times.	$47*

*actual reimbursement varies by region.

Basic CCM Breakdown

Per CMS, chronic care management is a critical primary care service that contributes to better patient health care and can also help to reduce geographical and racial disparities impacting patients. In order to qualify for the program, patients must:

Have two or more chronic conditions; and
Have been seen by their provider at least once in the past twelve months

The foundational CPT codes for chronic care management (CCM) are 99490 and 99439, also referred to as basic CCM.

For chronic care management services to qualify for reimbursement under CPT code 99490, the CCM services must meet several requirements:

Providers must spend at least 20 minutes providing CCM services to patients.
Providers must document the patient’s verbal consent to enroll in and receive CCM services.
Providers and patients must work together to develop a comprehensive care plan.

These requirements also apply to code 99439, which reimburses clinical staff for each additional 20 minutes spent in the same calendar month beyond the initial 20-minute requirement stipulated in 99490.

Here are the 2023 CPT codes for complex CCM, including descriptions and corresponding reimbursement rates:

2023 CCM Reimbursement Rates
CPT Code	Time Spent By Clinical Staff	Reimbursement
COMPLEX CCM
99487	At least 60 minutes per calendar month.	$133*
99489	Each additional 30 minutes in a calendar month.	$70*

*actual reimbursement varies by region.

Complex CCM Breakdown

Unlike basic CCM (code 99490), complex chronic care management (code 99487) requires more involved decision-making and time.

Here, clinical staff can bill for reimbursement if they provide care to patients for at least 60 minutes. Also both patient and provider must agree that there has been an acute exacerbation of the patient’s chronic condition for the care to meet the complex CCM criteria.

Clinical staff providing complex CCM are also reimbursed for each additional 30 minutes spent in the same calendar month providing patient care for exacerbated chronic conditions. These services are billable under add-on code 99489.

Below is the 2023 CPT code for behavioral health integration (BHI) reimbursable under CCM:

2023 CCM Reimbursement Rate
CPT Code	Time Spent By Clinical Staff	Reimbursement
BEHAVIORAL HEALTH
99484	At least 20 minutes per calendar month.	$43*

*actual reimbursement varies by region.

Behavioral Health Breakdown

Under CPT code 99484, clinical staff providing care management services for behavioral health conditions can bill for reimbursement if the services involve at least 20 minutes per calendar month. The provider must also obtain separate enrollment & consent forms and create a separate care plan.

Behavioral health integration (BHI) services covered under code 99484 may include:

Initial and continuous patient assessments
Care planning and revision
Coordination of behavioral health treatment

Scale Your CCM Program with Signallamp

Remaining up-to-date with changes to the CMS CPT codes is essential to minimizing delays in clinical staff reimbursements and ensuring your patients receive the best care. At Signallamp, we understand the need to engage patients longitudinally and bridge the care gap in between provider office visits, improving quality, outcomes and patient experience.

Using our personalized CCM model, we can help you scale up your CCM program to meet the needs of your patients and staff, all without any out-of-pocket expense or upfront capital. To learn more and get started, schedule a consultation!

^{1 CMS. Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule}

^{2 CMS. Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule}

^{3 CMS. Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule}

^{4 CMS. Chronic Care Management and Connected Care. https://www.cms.gov/about-cms/agency-information/omh/health-equity-programs/c2c/ccm}

^{5 CMS. Chronic Care Management and Connected Care. https://www.cms.gov/about-cms/agency-information/omh/health-equity-programs/c2c/ccm}

^{6 CMS. Behavioral Health Integration Services.}