CCP CCM Billing & CMS Guidelines 2 — Questions and Answers
Question 1: CPT code 99491 differs from 99490 in that it requires the billing provider to personally perform at least how many minutes of CCM services?
- 10 minutes
- 20 minutes (Correct answer)
- 30 minutes
- 60 minutes
Correct answer: 20 minutes
CPT 99491 requires the physician or qualified NPP to personally perform at least 20 minutes of clinical staff or direct CCM time per calendar month.
Question 2: Which CPT code is used to bill for each additional 20 minutes of complex CCM services beyond the first 60 minutes?
- 99439
- 99487
- 99489 (Correct answer)
- 99491
Correct answer: 99489
CPT 99489 is the add-on code for each additional 30 minutes of complex CCM time beyond the initial 60 minutes billed under 99487.
Question 3: Under CMS rules, which of the following services CANNOT be billed on the same day as a CCM service by the same provider?
- Annual wellness visit
- Transitional Care Management (TCM) (Correct answer)
- Prolonged office visit
- Advance care planning
Correct answer: Transitional Care Management (TCM)
CCM cannot be billed during the same month a TCM service is billed because TCM time counts toward CCM and the services overlap.
Question 4: Medicare's CCM benefit requires that a care plan be based on a physical, mental, cognitive, psychosocial, functional, and environmental assessment — known collectively as what?
- Comprehensive risk stratification
- Systematic disease registry review
- Comprehensive care plan (Correct answer)
- Chronic disease management protocol
Correct answer: Comprehensive care plan
CMS requires a comprehensive care plan that addresses all domains listed and is electronically shared with other treating providers.
Question 5: A CCM patient calls the practice at 8 PM on a Friday with a non-urgent question. The care coordinator spends 7 minutes answering. How does this time count for billing?
- It does not count; only business-hours contacts apply
- It counts toward the monthly CCM time log (Correct answer)
- It requires a separate after-hours billing code
- It can only be counted if a physician reviews the call
Correct answer: It counts toward the monthly CCM time log
All non-face-to-face clinical time related to CCM, including after-hours calls, counts toward the monthly time log as long as it is documented.
Question 6: Under complex CCM (99487), the minimum required time of clinical staff CCM services per calendar month is:
- 20 minutes
- 30 minutes
- 45 minutes
- 60 minutes (Correct answer)
Correct answer: 60 minutes
CPT 99487 requires at least 60 minutes of clinical staff time per calendar month for complex CCM patients requiring moderate or high decision-making.
Question 7: CMS specifies that only ONE provider per patient per month may bill CCM. If a patient's PCP is billing CCM and a cardiologist also wants to bill, what should happen?
- Both may bill if they document separate conditions
- The cardiologist may bill using add-on code 99439
- The cardiologist cannot bill CCM for the same patient that month (Correct answer)
- The cardiologist must obtain a separate written consent
Correct answer: The cardiologist cannot bill CCM for the same patient that month
CMS only allows a single billing provider to submit CCM for a given patient in a given calendar month; the other provider's time may be incorporated but not separately billed.
CCP CCM Billing & CMS Guidelines 2
CPT code 99491 differs from 99490 in that it requires the billing provider to personally perform at least how many minutes of CCM services?