M-CCM is voluntary. CMS does not compel healthcare organizations to participate. It’s all about whether you want to stay the course or improve your current Medicare care management and increase revenue by billing its related CPT odes.

• M-CCM is the solution that improves care management for patients, physicians, and nurses.
• It creates checklists and protocols to manage chronic disease for traditional Medicare patients via short-term nurse telephone visits. After an initiating visit, mid-level nurses conduct consultations, and providers confirm the diagnosis and treatment plan. The result is happier patients, improved care management, and a billable event that captures pmpm revenue.
• M-CCM will help you reimagine what it means to care for Medicare patients with chronic disease, because it takes care management and makes it proactive and relational, rather than reactive and transactional.

In their 2025 Final Rule, CMS states:

“We have implemented coding and payment for many care management services that are performed outside the context of a face-to- face, in-person visit—most often by the billing practitioner’s clinical staff on behalf of patients with complex health care needs. The Medicare CCM code families now include 5 sets of codes which are reported monthly on a timed basis, each set with a base code of 20 to 60 minutes and an add-on code for each additional 30 minutes.”

M-CCM Obstacles Have Proven to Be Difficult to Overcome

• Staffing levels continue to be challenged, depleted, and costly.
• Gaps in Care are identified by EHRs and payor sources, but closing those gaps is challenging.
• M-CCM was created to address the issues, but TINs and ACOs struggle to increase patient onboarding and demonstrate revenue gains.

The Program Allows For:

• Reimbursement for monthly telehealth visits by mid-level providers.
• Patients must opt-in to the program.
• Specific care management templates (policies) are required to make it a billable event.
• Billing is under the CPT codes:
  • Single Chronic Condition – 99424, 99425, 99426, 99437, and 99439.
  • Multiple Chronic Conditions – 99487, 99489, 99490, and 99491.

CPT 99490 is the general code used to determine If you are participating in M-CCM. Check with your billing to verify if you are currently submitting these codes.

Opportunities:

• Fewer than 3% of TINs / ACOs are Billing M-CCM Codes (cms.data.gov). Everyone is doing physician-based CCM. This means the competitive advantages M-CCM delivers can be substantial.
• Significant Financial Incentives. The additional revenue can make a huge difference in your bottom line.
• Improved Patient Care & Happier Patients. (Beyond traditional physician-based CCM programs).

Challenges:

• There are specific procedures that must be followed to make M-CCM a billable event.
• Implications On Operations. Additional staffing requirements and workload.
• Patient Engagement. There are specific policies that must be followed.
• Billing / Financial. Some degree of billing complication.
• Technology Integration. Complexity and training disruptions.
• Program Level Implementation. Integration can cause operational disruptions.

All these challenges are very easy to overcome with the right software technology platform.

M-CCM Billing is Complex

It is a Large-Scale Project.

• Who will do the heavy lifting to creates the significant new revenue – You or a vendor?
• Your organization must overcome complex issues across multiple clinics and/or doctors.
• M-CCM must align with the goals of your organization and physicians, which are related – but different.
• M-CCM requires the implementation of strategies that are tied your organization’s culture and relationship with ownership / board.
• Your organization or vendor must fully “staff up” for implementation.
• The effort must help your organization gain a unique advantage in overcoming the biggest obstacle to success (patient recruitment and onboarding).

This graph illustrates the complexity of a successful M-CCM effort.

 There are very specific patient onboarding policies that must also be followed.

It starts with answering several important questions:

1. 1.  What is your current M-CCM strategy?
   2. How do you envision implementing M-CCM?
   3. Should you outsource the heavy lifting?
   4. What are the qualifications you must identify in a vendor?
   5. Have you billed CPT 99490, 99491, 99487, 99489, 99424, 99425, 99426, 99437, and 99439 since the last CMS published data set? (If so, perhaps our proprietary software platform can help you).

M-CCM is a major new initiative for every clinic that goes down the path. In many ways, it is a lot like a business startup. Your best chance of success is to align yourself with a team experienced in big initiatives.

Our team is deeply experienced in healthcare and largescale program implementation and operations. And our comprehensive understanding of regulatory requirements and our advanced proprietary software technology, which our leadership team has a deep investment in – make us the ideal service partner.

And continuous updates in response to industry changes make our technology platform crucial for meeting quality metrics and achieving better patient outcomes.

We will transform your approach to M-CCM; making it more accessible, proactive, personalized, patient-centered, and effective for the Medicare patients you serve. It is offered on a Clinic-by-Clinic basis and features options that are tailored to your organization’s specific needs. It requires very little workload and no additional staffing requirements on your part.

Our M-CCM platform is the empowering solution that ensures you succeed with unparalleled technology, guidance, and support.

Understanding the benefits and implications of M-CCM helps in making the decision on whether to partner with a highly qualified vendor, or stay the course with your ACO, current vendor, or your own efforts – very easy.

We will show you what your M-CCM opportunity looks like. We will email you a pdf and jpeg image of a CMS M-CCM data snapshot on your organization, which will show you how much more revenue you can capture by billing CPT 99490 and its related codes.

The summary will break down the numbers for you in very simple language.

Because you need to know what is happening right now, you require a M-CCM Analysis, which is an invaluable tool to present to your decision makers, board, stakeholder, or to review other vendors. It will include an M-CCM Strategy Report and data spreadsheet that calculates your M-CCM opportunity based on PY 2024 and the current PY.

The execution of a BAA and our M-CCM Analysis Agreement is required (a non-refundable analysis fee applies).

If you are currently offering your eligible patients M-CCM and utilize your EHR for program management, you may require a software platform that integrates and provides all necessary billing data, our software-only option could be the perfect solution for you because its advanced software tools will scale your M-CCM efforts upwards.

If you only have one care manager and a small number of patients, your staff can manage the process manually. But as patient volume grows, those manual processes create errors and bottlenecks that will constrain efficiency and the ability to reach patients who will benefit from M-CCM.

In the 30-60-minute Zoom call, we will talk in detail about our core team and qualifications, our three service options, and the analysis that will provide you with something you will be proud to show your decision makers, ownership, board, and/or stakeholders.

Click Here or or see the link below to go to our Calendly page to reserve your Zoom call with us. Complete the required fields and when asked purpose of call click: M-CCM or M-CCM – Software-Only.

Take a few moments to download our brochures, platform details, and CMS data supporting materials below:

• Live Well A.P.S. Medicare CCM Full-Service Brochure (pdf).
• Live Well A.P.S. Medicare CCM Software-Only Brochure (pdf).
• Live Well A.P.S. Medicare CCM Platform Details (pdf).
• CMS MLN CCM Booklet (pdf).
• Medicare Chronic Care Management for Seniors (link).
• CMS Outreach and Education on CCM report (pdf).
• Mathematica 2017 report on CCM (pdf). (This is an important study, but a bit long.  See page 64 for the Bottom Line)