2025 Medicare CPT Code Reimbursements for Chronic Care Management (CCM)
This November, the Centers for Medicare and Medicaid Services (CMS) issued a Final Rule updating the Physician Fee Schedule. The schedule includes a list of prices, reimbursement rates, and billing codes for various healthcare services. It also covers costs related to chronic care management (CCM) and remote patient monitoring (RPM).
So, how did Medicare reimbursements from CMS for chronic care management change for 2025?
The most significant changes include discontinuing the CPT code G0511 for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Reimbursement rates for existing CPT codes will also be adjusted, and a new CPT code, Advanced Primary Care Management (APCM), will be added.
Let’s review how Medicare reimbursements from CMS for chronic care management have changed for the 2025 calendar year.
The 2025 Reimbursement Rates for the CMS CCM Codes
In 2025, the Relative Value Unit (RVU) Multiplier for all services and treatments billed to Medicare is $32.05, a slight decrease from 2024. The RVU-based conversions may vary depending on factors such as clinical specialty and geographic locations of facilities.
Below is a table of the 2025 CPT codes for CCM treatments and the average rates for each code.
*actual reimbursement varies by region.
The termination of CPT code G0511 explained
Beginning January 1, 2025, CMS unbundled G0511, allowing Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to bill the individual CPT codes for certain care management services like CCM & RPM. CMS is giving RHCs & FQHCs a transition period, allowing the option for G0511 to be billed through June 30, 2025 before making the switch mandatory.
The launch of the new Advanced Primary Care Management program
CMS launched a new program starting in January 2025, the Advanced Primary Care Management (APCM) program. APCM codes are not time-banded and will combine elements of several existing care management services, including CCM, TCM, and RPM services. A few notable components of the APCM program include:
- APCM requires a separate consent, i.e., if a patient has consented to CCM or RPM, you still need to get an additional consent for APCM.
- APCM codes are not time-banded and have three billing levels, each with separate requirements and RVU work values.
- APCM cannot be billed in the same month as CCM.
- APCM can be billed in the same month as RPM.
To broaden the eligibility, CMS is making APCM available to all patients, however, there will be levels to the reimbursements based on the care complexity and risk factors associated with a patient.
*actual reimbursement varies by region.
Complex CCM Breakdown
Basic CCM (code 99490) requires less medical decision-making and time compared to complex chronic care management (codes 99487 and 99489).
In order to meet complex CCM criteria, the patient and the provider must agree that there has been a noticeable aggravation of the patient’s condition to qualify for reimbursements. The provider must also provide at least 60 minutes of care to the patient in order to get reimbursed.
Each additional 30 minutes spent in the same month will count toward reimbursements for the provider. This is billable under the add-on code 99489.
Though the reimbursement codes and descriptions remain the same for 2025, the rates have slightly increased.
*actual reimbursement varies by region.
BHI Care Management Reimbursements
In 2025, CMS will continue to support Behavioral Health Integration (BHI) under chronic care management. The only difference will be seen in the slight increase of the reimbursement rate.
*actual reimbursement varies by region.
Maximize Your CCM and RPM Model with Signallamp
Remote patient monitoring and chronic care management require an efficient and supportive infrastructure for both providers and patients, especially when handling billing responsibilities. However, when juggling high patient loads and constantly changing regulations, providers need comprehensive support in order to continue providing effective CCM and RPM services to their patients.
With Signallamp’s help, providers can get the robust CCM and RPM support structure needed to sustain and grow their programs year after year. With a team of trained and dedicated nurses, streamlined enrollment and consent processes, and documentation directly into your EHR system, providers can rely on Signallamp Health to help them take care further while maximizing their financial performance.
Are you ready to create a sustainable RPM program? Schedule a consultation with Signallamp today.