Healthcare Insights
Top 9 chronic care management CPT codes
As the U.S. population ages, many individuals are living with chronic conditions. In fact, about 80% of older adults have a chronic condition, and 77% of those live with two or more, based on reports from the National Council of Aging.
For these millions of people, chronic care management helps improve their health and wellbeing and live active, independent lives. CPT codes track procedures and services related to chronic care.
What is chronic care management (CCM)?
Chronic care management services apply to Medicare recipients living with at least two chronic conditions expected to last at least 12 months. Healthcare providers use chronic pain care plans, which determine patient goals, action steps, dates and necessary resources to monitor patients’ diagnoses and progress.
Why is chronic care management important?
Chronic care management is important because it allows individuals living with chronic conditions to receive a higher level of care. The service provides support, manages medications and makes urgent care more accessible.
What conditions qualify for chronic care management (CCM)?
Many conditions qualify for chronic care management, including the top five chronic health conditions impacting population health:
- heart disease
- hospital-acquired infections
- nutrition & obesity
- prescription drug overdose
- alcohol dependence
How CPT codes can help you to understand CCM
What is a CPT code?
The American Medical Association (AMA) created the Current Procedural Terminology (CPT). CPT codes effectively report medical operations and services. In the case of chronic care management, there are specific CPT codes associated with chronic care services.
CPT codes can help you to understand CCM by describing the most utilized chronic care operations and services. Using CPT codes, healthcare providers in the CCM area can also streamline reporting with greater precision and effectiveness.
We compiled the top nine chronic care management CPT codes below to highlight which areas of CCM are seeing the most procedures.
9 most common chronic care management CPT codes
| Rank | CPT code | CPT code description | Total procedures 2021 | Total procedures 2020 | Explore dataset |
|---|---|---|---|---|---|
| 1 | 99490 | Chronic care management services, first 20 minutes of clinical staff time per calendar month | 1,667,559 | 1,911,937 | Explore |
| 2 | 99487 | Complex chronic care management services, first 60 minutes per calendar month | 123,131 | 145,801 | Explore |
| 3 | 99484 | Care management services for behavioral health conditions, 20 minutes per calendar month | 96,053 | 113,714 | Explore |
| 4 | 99491 | Chronic care management services, first 30 minutes provided by a physician per calendar month | 59,061 | 59,744 | Explore |
| 5 | 99489 | Complex chronic care management services, each additional 30 minutes per calendar month | 47,256 | 45,421 | Explore |
| 6 | 99483 | Assessment & care planning for a patient with cognitive impairment | 38,739 | 32,752 | Explore |
| 7 | 99485 | Supervision interfacility transport, first 30 minutes | 1,495 | 1,335 | Explore |
| 8 | 99486 | Supervision interfacility transport, additional 30 minutes | 308 | 253 | Explore |
| 9 | 99439 | Chronic care management services, each additional 20 minutes of staff time per calendar month | 254,154 | 43 | Explore |
Fig. 1 Data is from the Definitive Healthcare ClaimsMx product for calendar years 2020 and 2021. Commercial claims data is sourced from multiple medical claims clearinghouses in the United States and is updated monthly. Data is accurate as of January 2022.
Which CCM CPT code has the highest number of procedures?
The 99490 CPT code had the highest number of total procedures in 2020 and 2021: 1,911,937 total procedures in 2020 and 1,667,559 total procedures in 2021. This CPT code tracks chronic care management services for the first 20 minutes of clinical staff time per calendar month.
The average number of total procedures of the top 9 CPT codes was 256,778 in 2020 and 254,195 in 2021. The average number of total procedures of the top 9 CPT codes in 2020 and 2021 was 255,486.
Overall, these trends display that there have been mostly 20-minute clinical interventions within the CCM space. Interestingly, the third-highest CPT code is involved with behavioral health services, which relates to the increase in mental health utilization we saw in 2021. Healthcare providers can utilize this intelligence in choosing which treatments and services to offer.
Learn more
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians and other healthcare providers.
You might also be interested in...
