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Clinical Operations Guide
Chronic Care Management (CCM) Workflow & Revenue
Learn how to implement a high-performing CCM program that improves patient outcomes and adds a predictable, monthly revenue stream to your clinic.
How CCM Care is Performed
A simplified 4-step workflow for clinical teams.
Patient Enrollment
Identify patients with 2+ chronic conditions. Obtain verbal or written consent and document it in the system. Our platform makes this a 2-minute process.
Care Plan Creation
Develop a comprehensive care plan directed at all health concerns. The platform provides smart templates based on diagnoses to ensure CMS compliance from day one.
Monthly Care Management
Provide 20+ minutes of non-face-to-face care per month. This includes phone check-ins, remote chart reviews, and coordination with laboratories or specialists.
Automated Billing
Once the 20-minute threshold is triggered, the system flags the patient for billing. One click generates the CMS-ready claims and PDF attestations.
Revenue Potential
How Much You Can Earn
CCM provides a predictable monthly revenue stream. Unlike office visits, CCM is billed every single month as long as clinical criteria are met.
CPT 99490
Initial 20 Minutes (Staff)
~$62
Per Patient / Month
CPT 99439
Each Add'l 20 Minutes
~$47
Additional Unit
CPT 99491
Initial 30 Minutes (Provider)
~$85
Per Patient / Month
Annual Revenue Example
Patients Enrolled
100
Avg Reimbursement
$62
Estimated Monthly Revenue
$6,200
Estimated Gross Annual Revenue
$74,400
Note: Actual rates vary by geographic location and CMS adjustments. These figures are based on 2024 national averages.
When is a Code "Completed"?
CMS requires **20 minutes of non-face-to-face clinical staff time** per calendar month to bill the base CCM code (99490).
Automated Time Tracking
CareReimburse tracks every minute spent on phone calls, chart reviews, and coordination automatically.
Real-time Completion Alerts
The dashboard notifies you the moment a patient reaches the 20-minute threshold.
Consent: SIGNED
Care Plan: UPDATED