Chronic Care Management (CCM) can be a solid revenue stream and more importantly a patient care enhancer—if done right. But let’s not pretend it’s simple. It comes with administrative baggage, compliance landmines, and often a whole lot of confusion. So is it worth it? In this blog we tell you what you need to know.

What Is Chronic Care Management?

CCM is a Medicare-covered service that allows providers to be reimbursed for non-face-to-face care coordination of patients with two or more chronic conditions expected to last at least 12 months (or until death), and that place the patient at significant risk of death, acute exacerbation, or functional decline.

It’s often billed under CPT code 99490 for at least 20 minutes of clinical staff time per calendar month, with add-on code 99439 available for more time. There are codes for physicians personally performing the service, however these services are typically carried out by clinical or auxiliary staff. 

✅ The Pros of Billing for CCM

• Revenue Boost Without Office Visits
  You’re getting paid for work your team is already doing—like coordinating care, monitoring care plan goals, managing meds—without having to see the patient in person.
• Better Patient Outcomes
  CCM leads to stronger relationships with patients and better chronic condition management, which often reduces ER visits and hospital admissions.
• Practice Differentiation
  Offering CCM shows a proactive, high-touch approach to care that can set your practice apart and increase patient loyalty.
• Helps Meet Quality Measures
  CCM can contribute to your MIPS performance, especially under the “Improvement Activities” and “Care Coordination” categories.

⚠️ The Cons (What They Don’t Tell You)

• It’s Labor-Intensive
  Tracking minutes, documenting services, building care plans, and managing outreach—it takes real infrastructure to do it right.
• Patient Consent & Enrollment Is Often Mishandled
  If you’re not capturing verbal or written consent (and documenting it), you’re setting yourself up for an audit nightmare.
• Technology Requirements
  You need an EHR with care plan sharing capabilities, or a third-party platform. 
• High Dropout Rates
  Patients often don’t understand they’re being billed monthly (usually $8–$12 copay), and will opt out if you don’t communicate the value clearly.
• It Can Tank Morale if Dumped on the Wrong Staff
  This isn’t just “nurse check-ins”—CCM requires strategic staff allocation and ongoing training. Otherwise, it becomes a burden.

🧠 Common Pitfalls to Avoid

• Not documenting time properly – You must document who provided the service, what was done, and exact time spent. Vague notes like “CCM call – 20 minutes” won’t cut it.
• Billing for time you can’t prove – If you’re audited and can’t produce care plans, call logs, or patient engagement, Medicare will deny payment—and clawbacks are real.
• Billing CCM with overlapping services – You can bill CCM and services like TCM in the same month, but you must document separate, non-duplicative time and services. Make sure the care coordination provided under each code stands on its own to avoid denials or recoupments.
• Missing care plan requirements – A comprehensive, patient-centered care plan must be established, shared, and accessible. Many practices overlook this.
• Using Spreadsheets Without EHR Integration
  Tracking time in a spreadsheet isn’t wrong, but it becomes risky if the details can’t be tied back to the patient’s medical record. If you’re using spreadsheets, make sure that data is accurate, auditable, and reflected in the EHR or care management system. Medicare auditors expect full visibility of services billed.

Bottom Line: Is CCM Worth It?

Yes—but only if you commit.
CCM isn’t a “set it and forget it” add-on. It’s a clinical and operational commitment. When you staff it right, document it tight, and explain it well to patients, it can improve care and boost revenue.

If you’re not ready to invest in structure and workflow, skip it for now. But if you are, CCM can absolutely pay off.

Make sure to read and understand what is needed from CMS directly! Reference below:

Ref: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf