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How to Use Phamily to Bill for CCM

Follow these guidelines to download the Phamily billing report and submit claims for CCM services.

Ishan Ghildyal avatar
Written by Ishan Ghildyal
Updated over a year ago

What are the requirements to bill a patient for CCM?

The following must be met in order to bill for CCM services:

  1. Patients must have a Care Plan that has been shared with them

  2. Patients must have provided consent to participate in CCM

  3. Patients must have a minimum of 20 minutes of care management time documented

NOTE: CMS permits CCM consent to be obtained in various manners that are best suited to the patient: In writing (electronically by text or email message, through the EHR, or on paper) or verbally (by phone or during an in-person discussion). All such forms of consent are equally valid.

Check out our article on CCM Consent & PHI Authorization to learn more.

When should I bill for CCM?

The first week of every month, submit bills for the previous month (e.g., on October 1st, submit your September CCM bills). Service date is the last date of the month of service.

NOTE: We recommend billing for services only at the end of the calendar month. Even when patients have reached 20+ minutes of care, we recommend that you wait to process claims after the close of the calendar month because patients may continue to accrue additional minutes of care management time.

You can use add-on codes for every incremental 20 minutes of care delivered during a calendar month.

How do I download the Phamily Billing Report?

  1. Log in to Phamily.

  2. Click Enrolled at the top of the page.

  3. Click the down arrow next to the NO PHI filter and select PHI CONSENTED

  4. Click the green Ready to Bill button on the right side of the Enrolled Patients page. This will show a filtered view of all patients with a care plan and 20+ minutes of care management logged.

  5. The date at the top of the page will default to the current month. Click the date and select the previous month.

  6. Click the Download button to export your CCM billing spreadsheet. This spreadsheet contains details on all patients eligible to bill for CCM and which CCM code(s) they qualified for that month.

NOTE: Once downloaded, the Ready to Bill report will contain all CCMs codes that patients are eligible for during that month. This includes noncomplex, complex, and add-on codes. CCM managers should remove the codes that do not apply - do this by deleting the codes from the spreadsheet.

How do I ensure successful reimbursement?

  1. Make sure the patient has been seen by the billing provider within the past 12 months. Patients must be have had a qualifying E/M visit (99212-99215, etc.), Annual Wellness Visit (AWV), or Initial Preventive Physical Examination (IPPE) within the past 12 months.

    1. For patients who are new to the billing provider's practice, the provider can enroll them right away if they have discussed CCM at one of these visits.

  2. Bill each claim as its own – do not combine claims together. For example, if a patient receives 60+ minutes of non-complex CCM, then bill 99490 x 99439 x 99439 each on their own claim.

  3. Patients may only receive CCM services from one provider each month.

  4. CCM cannot be concurrently billed with the following services:

    1. Home Health Care Supervision (HCPCS G0181);

    2. Hospice Care Supervision (HCPCS G0182);

    3. Transitional Care Management (CPT 99495, 99496); and

    4. Certain ESRD Services (CPT 90951-90970).

NOTE: CCM can be billed during the same month as Principle Care Management (PCM) by different billing providers who have different TINs.

Need help?
Contact our Support Team at support@phamily.com, or click the question mark in Phamily, for assistance.

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