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Stop the CCM Spreadsheet Nightmare.

CCM pays for the “between-visit” work your team already does—care coordination, patient outreach, and updating an electronic care plan—billed by the calendar month under general supervision of the billing practitioner.[1] FairPath automates time capture, enforces CMS stacking rules, and generates clean, auditable claims.

Calculate Your CCM Revenue See How We Automate Time-Tracking ↓

CCM: Great for Patients, Brutal Without Automation.

CMS built CCM to reward longitudinal, team-based care for patients with 2+ chronic conditions. The catch: precise minutes, consent, initiating visits, 24/7 access, an electronic care plan, and strict concurrency rules.[1]

Manual Minutes = Missed Claims

Trying to hand-log 20+ minutes across dozens of micro-tasks is why many patients stall at 18 minutes and never get billed.

Common Audit Traps

Double-counted time, missing consent/initiating visit, and prohibited stacking with other services trigger denials and clawbacks.[1]

Revenue Left on the Table

Without guardrails, most programs under-bill the base 20 minutes and rarely capture lawful add-on time.

From Manual Logs to Automated, Auditable Revenue

Step 1: Automate Time Logging

FairPath captures clinical-staff time for calls, patient/caregiver communications, chart work, referrals, and care-plan updates—accumulating toward 99490/99439 or practitioner-time 99491/99437 with a defensible audit trail.[1]

Step 2: Enforce Concurrency Rules

Our Compliance-as-Code engine blocks prohibited overlaps: complex vs non-complex CCM, prolonged E/M with complex CCM, and enforces the rule that CCM can pair with either RPM or RTM—but never both for the same patient period—so there’s no double-counting of minutes.[1] [6]

Step 3: One-Click Claim Files

At month-end, FairPath surfaces patients who meet time and documentation elements (consent, initiating visit, electronic care plan, 24/7 access, transitions) and generates clean claim files.[1]

Coordinate the Whole Panel

CCM is one piece. FairPath orchestrates CCM with RPM/RTM and, when appropriate, APCM—while preventing billing conflicts.

FairPath Total Care Diagram

CCM runs under general supervision for clinical staff. Only one practitioner can bill CCM per patient per calendar month. APCM is billed once monthly and incorporates CCM-like elements—choose APCM or CCM for the same patient/practitioner in the same month to avoid duplicate payment.[1] [2]

Who Qualifies & What’s Required

Eligibility: 2+ chronic conditions expected to last ≥12 months (or until death) and posing significant risk; CCM is billed by the calendar month.[1]

Before billing: complete an initiating visit (E/M, AWV, or IPPE), obtain and document patient consent, maintain a comprehensive electronic care plan in certified EHR tech, ensure 24/7 access, and manage care transitions.[1]

Who furnishes: clinical staff may furnish CCM incident-to under general supervision; practitioner-time codes (99491/99437) require time personally by the billing practitioner.[1]

The Financials (Without the Guesswork)

Use our calculator (built on CMS PFS files) to estimate locality-specific amounts. If you prefer, look up current Medicare amounts directly in the official PFS Look-Up Tool.[3] [4]

Estimate Your CCM Revenue

Note: Patient cost-sharing applies to CCM; supplemental insurance may cover coinsurance.[1]

What’s Changing in 2026?

CMS finalized APCM refinements, including optional behavioral-health add-on codes (modeled on CoCM/BHI), and remote-monitoring policy updates in the CY 2026 PFS final rule. We keep our rules engine and calculator aligned with official files and MAC guidance.[5]

Your CCM Compliance Questions, Answered

Yes—CMS allows CCM with either RPM or RTM if each service independently meets requirements and you don’t count time twice. You can’t bill RPM and RTM together for the same patient period; CCM can only pair with one or the other.[1] [6]

Not by the same practitioner for the same patient in the same month. APCM is billed once per calendar month and incorporates CCM-like elements—choose APCM or CCM for that month/patient/practitioner to avoid duplicate payment.[2] [1]

Care coordination and management activities like medication reconciliation, care-plan creation/revision, patient or caregiver communications, chart and lab review, referrals and follow-up, and managing transitions. Track only CCM-eligible minutes and don’t reuse those minutes for other billed codes.[1]

Clinical staff (employees or contracted) may furnish CCM incident-to under general supervision of the billing practitioner; the practitioner provides overall direction and does not need to be physically present. Practitioner-time codes (99491/99437) require time personally by the billing practitioner.[1]

Yes. For new or long-lapsed CCM patients, complete an initiating visit (E/M, AWV, or IPPE) and obtain/document patient consent (cost-sharing, that only one practitioner bills per month, and the right to stop anytime).[1]

No. Don’t report 99487/99489 in the same calendar month as 99490/99439. Also, don’t pair practitioner-time CCM (99491/99437) with clinical-staff CCM for the same patient/month.[1]

Yes. CCM thresholds and codes are calendar-month based. This differs from device-supply codes in RPM/RTM, which use 30-day periods.[1] [6]

Use the CMS PFS Look-Up Tool or National Payment Amount files for current locality-specific amounts. We also surface these values in our calculator.[3] [4]

RHCs/FQHCs may bill CCM and TCM for the same patient during the same period, and they follow distinct billing mechanics. Confirm current MAC guidance for your setting and be aware of the transition away from blended G0511 toward underlying care-management codes and APCM in 2025–2026.[1] [5]

References

  1. CMS MLN Booklet: Chronic Care Management Services (ICN MLN909188, June 2025). Includes eligibility, initiating visit & consent, electronic care plan/EHR, 24/7 access, supervision, and code times.
    PDF
  2. CMS MLN Booklet: Chronic Care Management Services (ICN MLN909188, June 2025) – concurrency and stacking. Clarifies interaction with RPM/RTM, TCM, complex vs non-complex CCM, ESRD, home health, hospice, and other care-management codes. Same document as [1], focused on the concurrency sections.
  3. CMS: Advanced Primary Care Management (APCM) Services overview (May 12, 2025). Monthly bundle; auxiliary personnel under general supervision; integrates CCM-like elements and supports hybrid primary care payment models.
    Web
  4. CMS: PFS Look-Up Tool Overview (official rate lookup).
    Web
  5. CMS Fact Sheet: CY 2026 Medicare Physician Fee Schedule Final Rule (Oct 31, 2025). Describes APCM refinements, APCM behavioral-health add-on codes (G0568–G0570), and related updates to care-management and remote-monitoring policy.
    Web
  6. HHS Telehealth Guidance: Remote Patient Monitoring and Remote Therapeutic Monitoring (2024–2025). Clarifies that RPM and RTM can’t both be billed for the same patient and time period, and how they interact with CCM and other care-management services.
    Web