Chronic Care Management (CCM) Billing Services
CCM billing services are responsible for the coding, claims process, compliance, and denial management of CCM services. With the help of UControl experts, providers are able to receive full payment from Medicare for their care coordination. UControl is providing CCM billing services across all 50 states.
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What Is CCM Billing?
Coding and billing CCM is the activity of coding and billing Medicare for chronic care management, which is a Medicare program that provides reimbursement for the coordination of care outside of office visits. This activity has a goal to turn the recorded care-coordination time into reimbursable claims.
Chronic Care Management is a Medicare Part B program introduced in 2015, and it provides payment for coordinating care of patients with two or more chronic conditions. This process is provided between office visits and involves care-plan revisions, medication reconciliation, and coordination with other medical specialists. Medicare reimburses this service under certain codes (CPT and HCPCS).
CCM Billing is the revenue cycle that helps turn this clinical activity into an appropriate claim. Coding the right CPT or HCPCS code for the time spent; verifying the documents related to eligibility and patient consent and sending the claim within the month are the activities that should be performed according to each requirement of Medicare, not best practices.
What the program will pay for
Care coordination services for patients with at least two chronic conditions for which care is likely needed for at least 12 months without face-to-face visits.
Why billing will process monthly
Codes for CCM programs are reset every calendar month. Recorded minutes do not carry over, and therefore, billing is done monthly
What billing will control
Choice of code, time threshold validation, consent and eligibility validation, claims processing, and denials appeals.
Who will be billing it
One provider per patient per month. Clinical staff perform the billing activity under general supervision.
What Our CCM Billing Services Include
CCM claims billing includes all phases of the revenue cycle from eligibility verification to denials management. Our experts perform these billing processes for you, not just clinical activities. While you deliver the patient care, we take care of billing.
Eligibility verification
We make sure that your patients have more than two chronic diseases which will persist for 12 months as per the Medicare CCM criteria.
Monthly time-log audit
We audit the clinical staff time according to the monthly threshold before filing the claim to ensure that no claim is billed below the minimum.
Consent and initiating visit checks
We make sure that there is documented patient consent and an initiating visit before sending our first claim
Code selection
We choose the right CPT or HCPCS codes for your CCM patients.
Claim submission and scrubbing.
Claims are scrubbed for coding and documentation errors prior to their being submitted to the payer
Reconciliation reports
Each month we provide reports reconciling the claims billed versus the payments received.
Denial management and appeals
Our process for managing and appealing denied CCM claims occurs based on the root cause of the denial.
Concurrency screening
We screen all patients to prevent duplicate billing in any program or practitioner during the same month.
CCM code family with 2026 national non-facility rates
| Code | Descriptor | Time threshold | 2026 rate |
|---|---|---|---|
| 99490 | Chronic care management, clinical staff time, first increment | First 20 minutes, per calendar month | ~$66 |
| 99439 | CCM, each additional increment of clinical staff time | Each additional 20 minutes, max 2 units | ~$50 |
| 99491 | CCM provided personally by physician or QHP | First 30 minutes, per calendar month | ~$86 |
| 99437 | CCM, each additional increment of physician or QHP time | Each additional 30 minutes | ~$63 |
| 99487 | Complex CCM, moderate to high complexity MDM | First 60 minutes clinical staff time | ~$144 |
| 99489 | Complex CCM, each additional increment | Each additional 30 minutes | ~$78 |
| G0506 | Initiating-visit add-on for extensive assessment and care planning | Once per patient, at initiation |
Two guidelines dictate how the billing is done for these codes. One provider should only be able to bill for CCM per patient per calendar month. Most of the duties are done by the clinical team with general supervision, which means that the billing provider supervises without having to be physically present. Time does not carry over into the next month.
What Are the APCM Codes (G0556, G0557, G0558)?
Advanced Primary Care Management, applicable from 2025, replaces the requirement to track time with three bundles of monthly services based on patient complexity. APCM pays a flat rate regardless of whether 10 minutes or 60 minutes are logged each month. This is appropriate for practices that cannot track time.
G0556 covers a patient with one chronic condition for about $16 per month. G0557 covers two or more conditions for about $54. G0558 covers two or more conditions plus Qualified Medicare Beneficiary for about $117. There must be 13 service elements available each month but not necessarily provided. The full list is found in the CMS APCM policy.
In the 2026 Physician Fee Schedule, three behavioral health add-on codes were added to APCM: G0568, G0569, and G0570. They have no time-based documentation requirements. APCM also requires value-based reporting through the Value in Primary Care MIPS Value Pathway and qualifying accountable care models.
CCM Billing vs a Clinical CCM Vendor
A clinical CCM vendor and a CCM billing partner solve different problems. UControl Billing supplies the revenue cycle behind the program. We are not a care-coordination staffing vendor, and that distinction changes what you should expect from us.
Clinical CCM vendors supply care coordinators and run patient phone calls. They also handle enrollment outreach. They deliver the care and log the minutes. UControl works the billing side of that same program: code selection, claim submission, and appeals. We plug into whatever clinical platform or in-house team you already run.
A practice using a clinical vendor still needs a billing-side audit. The vendor’s time logs are the exact records Medicare audits during a CCM review. We check those logs against the thresholds and documentation rules before the claim ships. That separation is why practices run both a clinical partner and a billing partner without overlap.
What CCM Can and Cannot Be Billed With
CCM bills alongside some care management programs and conflicts with others. Clinical time can never count twice, and each program’s requirements must be met on their own. The matrix below reflects current CMS care management guidance.
| Program with CCM | Same month? | Rule |
|---|---|---|
| RPM | Allowed | Time is tracked separately and never double-counted across programs. |
| BHI | Allowed | Requires advance consent for both, with each program's elements met independently. |
| TCM | Conditional | Allowed only if the 30-day TCM period ends before the month closes. |
| PCM | Restricted | Not by the same practitioner. Different providers may bill for different conditions. |
| APCM | Not allowed | APCM bundles CCM, so the two never bill for the same patient month. |
There is one main cause that causes most concurrency denials. There are two vendors billing CCM for the same patient in the same month, and Medicare does not pay any of them directly. We have an eligibility screening where we check all our patients against existing programs and practitioners before we send it.Concurrency policies referenced from CMS MLN909188 Chronic Care Management Services and current CMS care management guidelines.
Uncertain about the program that suits your panel?
We conduct an audit of your existing CCM claims and perform a CCM analysis against APCM for each patient.
How Onboarding Works With UControl
The process of Onboarding starts with Audit and ends with Monthly reporting through Four Stages. The process begins with an Audit of claims and time logs, followed by Payer and program modeling, parallel-run of first cycle, and lastly steady-state monthly reporting.
Audit current claims and time logs
An audit of the current CCM claims and monthly time logs is performed as per the standards of Medicare for identifying any gaps.
Payer and program setup with modeling
Payers are configured and modeling of CCM versus APCM is done across the panel. Codes are selected at this stage.
Parallel-run of first billing cycle
This stage involves parallel-run of the first billing cycle along with your current process for verification of cleared claims.
Steady-state monthly reporting
Monthly Billing and Reconciliation Reporting of your finance metrics.
Why Practices Choose UControl Billing
We charge care management services, all under one roof, from eligibility through appeals. No qualifying necessary for the following positioning statement, and we will furnish any performance metric upon request, not just claim it.
USA-based, covering all 50 states
Billing of care management practices and facilities throughout all 50 states under current CMS regulations.
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Specialty aware RCM
We handle care management services starting from eligibility, coding, submission, and appeals processes.
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Care management under one roof
We bill CCM along with TCM, PCM, BHI, and RPM without passing your business to another vendor.
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Program modeling prior to claims
We calculate the CCM vs. APCM ratio on your patient population prior to making claims decisions.
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Our Credentials
We hold the certifications that payers and auditors look for, and our coders carry the right credentials. It’s not the most exciting part of the work, but it’s the part that keeps your claims on solid ground.
Explore Frequently Asked Questions
CCM billing involves the coding process, claim submission, and denials protection of Medicare CCM service codes. This includes the reimbursement of non-face-to-face care coordination provided to patients with at least two chronic conditions each calendar month.
In CCM billing, 99490 and 99439 are used for clinical staff time, 99491 and 99437 for physician time, while 99487 and 99489 are used for complex CCM. The G0506 code represents initiating visit add-on and is billed once for each patient.
Yes. CMS permits concurrent CCM and RPM billing for the same patient where each program satisfies its respective criteria. It is crucial that time spent on clinical activities is recorded separately without minutes counting towards both services.
CCM bills based on the documented clinical staff time spent each month. APCM bills are based on a fixed fee per month as defined by patient complexity without any documentation of time. You cannot bill both codes for the same patient in the same month.
No, since CMS had transitioned RHCs and FQHCs out of the bundled G0511 code into individual CCM/APCM codes by January 1, 2026. Now, these centers will bill on national non-facility PFS rates.
It varies with your panel size and programs that you offer, therefore it would be misleading to provide a single figure. We start by providing an initial audit of your CCM claims for free and we provide your estimate after.