Care Coordination Billing Codes and Reimbursement

Care Coordination Billing Overview

Care coordination codes reimburse primary care practices for non-face-to-face patient management work — phone calls to specialists, medication reconciliation, care plan updates, and discharge follow-up. Chronic care management (99490) covers patients with 2+ chronic conditions. Complex care management (99487, 99489) covers patients requiring substantially more coordination time. Medicare reimburses 99490 at approximately $42 per patient per month.

Key Billing Codes

1. 99490 (CCM, 20 minutes/month) — base chronic care management for patients with 2+ chronic conditions. Reimburses ~$42/month under Medicare.
2. 99491 (CCM, 30 minutes by physician/QHP) — when the physician personally provides the care coordination time. Reimburses ~$86/month.
3. 99487 (Complex CCM, 60 minutes) — for patients requiring substantially more coordination: multiple specialist referrals, care transitions, complex medication regimens. Reimburses ~$93/month.
4. 99489 (Complex CCM, each additional 30 minutes) — add-on to 99487. Reimburses ~$46 per additional 30-minute block.

Documentation and Time Tracking

All care coordination codes are time-based. The practice must track cumulative minutes across the calendar month. Only clinical staff time counts — scheduling calls and billing activities do not qualify. Document: date, staff member, activity performed, time spent, and clinical outcome. The patient must consent to CCM services and acknowledge the monthly copay. Consent is required once and must be documented in the chart.

Common Denials

PR-1 (missing information) occurs when consent documentation is absent. CO-50 flags non-covered service — verify the patient has 2+ documented chronic conditions. CO-18 (duplicate) occurs when two providers bill CCM for the same patient in the same month. Only one provider per patient per month. See chronic care management for detailed setup guidance.