May 20, 2025 | Care Management CPT Codes: How to Bill with Confidence
May 20, 2025 – Jacksonville, FL
If you’re new to care management billing, you’re not alone. Many providers are already delivering valuable services – like chronic disease education, medication follow-ups, and care coordination – without realizing these can be billed. That’s where CPT (Current Procedural Terminology) codes come in. These codes are the standardized language of billing, ensuring providers are paid for the time, expertise, and support they offer patients.
But using CPT codes effectively isn’t just about knowing the codes themselves. It’s about understanding which services you already perform that can be billed, how to document them, and how to set your practice up for successful billing from day one.
Recognizing Billable Care Management Encounters
Providers often perform care management tasks without realizing they are billable. Routine follow-up phone calls to check in with a patient about medication changes or symptom management, updating care plans based on new information, offering personalized health education to guide patients with chronic conditions, and coordinating care by communicating with specialists, pharmacies, or family caregivers – all encounters that may qualify for billing under the right CPT codes if properly documented.
Key Care Management CPT Codes to Know
Chronic illness isn’t just a clinical phenomenon; it’s a narrative one. And too often, the healthcare system speaks in the wrong genre. It prescribes when it ought to ask. It measures when it ought to listen. At Wellbox, our model emphasizes continuity, context, and compassion. Most CCM companies value efficiency over human connection, making care into a transaction instead of a relationship.
Chronic Care Management (CCM)
99490: 20 minutes of non-complex CCM (clinical staff)
99439: Additional 20-minutes of non-complex CCM
99491: 30+ minutes of provider-based care
99487: 60 minutes of complex CCM
99489: Additional 30-minutes of complex CCM
Principal Care Management (PCM)
99424: 30 minutes of direct care management (physician or QHP)
99425: Additional 30 minutes
99426: 30 minutes of care by clinical staff
99427: Additional 30 minutes
Transitional Care Management (TCM)
99495: Non-complex TCM (14 days after discharge)
99496: High complexity TCM (7 days after discharge)
Remote Patient Monitoring (RPM)
99453: Initial device setup
99454: Device supply and data collection
99457: 20 minutes of RPM (clinical staff)
99458: Additional 20 minutes
Advanced Primary Care Management (APCM)
G0556: Comprehensive care management for chronic conditions
G0557: Additional support for high-risk patients
G0558: Care for Qualified Medicare Beneficiaries (QMB) with chronic conditions
Setting Up Care Management Billing
If you’re new to billing for care management services, it’s important to understand the foundational steps that ensure compliance, maximize revenue, and help you deliver better care. Billing begins with thoughtful preparation and workflow alignment.
Identify Your Services: Decide which care management programs you want to offer (CCM, PCM, TCM, RPM, or APCM) based on your patient population and practice capabilities.
Establish Documentation Protocols: Make sure your team understands how to document each encounter, including the time spent, the nature of the interaction, and the care provided.
Secure Patient Consent: Before providing billable services, obtain documented consent from patients. Explain what they can expect, the benefits, and any applicable co-pays. Renew this consent annually.
Educate Your Team: Determine who on your team will deliver services (clinical staff vs. QHPs) and train your staff (and providers) on the requirements of each CPT code, including who can deliver services and how they should be tracked.
Leverage Technology: Use your EHR system to flag eligible patients and automate time tracking where possible. Proper tracking ensures compliance and maximizes reimbursement.
Taking the time to build a process around these steps will ensure compliance, drive better patient outcomes, and unlock a steady revenue stream from services you may already be providing.
Maximizing Revenue with Strategic Billing
Using CPT codes effectively requires careful attention to documentation. Providers should ensure that time and services are tracked separately for each care management program. Only bill for what was actually provided, and strategically combine codes where allowed, such as billing CCM and RPM together when services are distinct.
Which codes can be billed together?
CCM (Chronic Care Management) and RPM (Remote Patient Monitoring): These can be billed together as long as time is tracked and documented separately. For instance, if you provide CCM services like care plan updates and RPM for monitoring blood pressure, each service can be billed without overlap.
CCM and TCM (Transitional Care Management): These can also be billed together, but you must ensure that the time and services for each are clearly distinct. TCM covers post-discharge follow-up, while CCM handles ongoing chronic care.
PCM (Principal Care Management) and CCM: These can be billed together, but they must cover different conditions. For example, PCM may be used for managing a single complex condition like heart failure, while CCM could cover multiple other conditions like diabetes and hypertension.
RPM and TCM: These can be billed together, provided the RPM is used for ongoing monitoring and not directly tied to the TCM service.
APCM (Advanced Primary Care Management) and Other Codes: Because APCM is a comprehensive, non-time-based service, it may overlap with other care management codes, but clear documentation is critical to avoid duplication.
Understanding and leveraging CPT codes for care management can transform the way you support your patients and sustain your practice. By recognizing billable encounters, selecting the right codes, and setting up efficient documentation and billing workflows, providers can unlock significant revenue while ensuring patients receive the care they need.
CPT codes can be complex, but you don’t have to handle them alone. Wellbox’s experienced care management team supports providers with program implementation, compliance, documentation, and billing. Our team works as an extension of your practice, allowing you to focus on delivering exceptional in-office care andthe ability to offer more without overextending your staff. Ready to explore further?
