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CHRONIC CARE MANAGEMENT

The CCM Revenue Sitting in Your Patient Panel

CMS pays $64.02 per patient per month for chronic care management. Most organizations capture a fraction of what they’re eligible for. The math is simple. The execution is where it breaks down.
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THE CHALLENGE

Your CCM Revenue Is Theoretical Until Someone Captures It

You know CCM is reimbursable. You may have even tried to stand up a program. But the numbers never matched the projections.

Eligible patients go unidentified. Enrollment stalls after the first quarter. Monthly outreach falls behind because clinical staff get pulled into higher priority work. Documentation gaps make claims vulnerable to audit. And the revenue that looked so promising on a slide deck stays theoretical.

This isn’t a failure of intent. It’s a failure of bandwidth. Your team has the clinical capability to deliver CCM. They don’t have the operational capacity to sustain it at the scale your patient panel demands.

CPT 99490 pays $64.02 for 20 minutes of CCM service per patient per month. CPT 99439 adds $47.44 for each additional 20 minutes, billable up to twice per patient per month.

At 250 patients on CPT 99490 alone: $16,005 per month. $192,060 per year.

Add 99439 billing for even a portion of those patients and the total climbs significantly. This is revenue CMS is ready to pay. The question is whether your organization can operationally capture it.

ROOT CAUSE

The Revenue Gap Is the Symptom. The Deeper Issue Is What Uncaptured CCM Means for Your Entire Chronic Population.

The revenue gap is the symptom. The deeper issue is what uncaptured CCM means for your entire chronic population.

  • Every month without CCM outreach is a month of unmanaged chronic disease.

    Patients with diabetes, COPD, heart failure, and other complex conditions don’t pause their disease progression because your team is too busy to call them. They miss medication adjustments. They skip follow up labs. They avoid specialist referrals they don’t understand. By the time they show up in your system again, it’s often in the ED.

  • Uncaptured CCM also means uncaptured risk adjustment data.

    Every CCM touchpoint is an opportunity to document ICD-10 Z codes and update the clinical picture. When those touchpoints don’t happen, your risk scores stay artificially low, your capitated payments shrink, and you lose revenue across every value based contract. This compounds. Year over year, your organization’s risk profile drifts further from reality.

  • The competitive exposure is growing.

    CMS has consistently increased CCM payment rates since the program launched. Organizations that build CCM infrastructure now are capturing revenue and strengthening patient relationships. Organizations that wait are watching patients with multiple chronic conditions receive better care management from competitors who made the investment.

OUR APPROACH

We Capture the CCM Revenue Your Panel Supports

We operate as a turnkey extension of your clinical team, handling the full CCM lifecycle from eligibility identification through billing submission.

  • Eligibility analysis and enrollment

    We identify CCM eligible patients in your panel and manage the enrollment process, including patient consent and care plan initiation.

  • Structured monthly outreach

    Our clinical specialists deliver condition specific, evidence based outreach every month. Every call follows structured workflows designed to activate patients, not just check a documentation box.

  • Complete billing capture

    We manage documentation for CPT 99490 and 99439, ensuring every billable minute is captured, compliant, and audit ready.

  • White labeled under your brand

    Patients never know they’re talking to an external team. Your brand, your protocols, your escalation paths.

  • EHR integrated

    We document directly in your EHR. No separate systems, no reconciliation, no data gaps.

See our full Chronic Care Management approach

RELATED CHALLENGES
PROVEN AT SCALE

Built to capture every billable minute

We manage the full CCM billing lifecycle so your organization captures the revenue your patient panel supports.
$192,060
Projected annual reimbursement at 250 patients (CPT 99490)
$47.44
Additional per patient per month (CPT 99439, up to 2x/month)
99.4%
Quality KPI pass rate
HIPAA
SOC 2 & NIST compliant

See the CCM revenue in your patient panel

We’ll show you the reimbursement opportunity sitting in your existing chronic patient population and how to capture it without adding headcount.

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