Can we bill CCM and RPM for the same patient in the same month?
Yes — CCM and RPM stack, as long as the time is tracked separately and never double-counted. Sansera's ledger enforces that separation automatically.
SanseraCCM360™ · Chronic Care Management
CCM revenue your practice has already earned. Our AI goes and gets it.
Two-thirds of Medicare patients qualify for Chronic Care Management. Almost none are enrolled — because CCM demands consent, care plans, monthly outreach, and minute-by-minute time logs your staff doesn't have time to keep. SanseraCCM360™ does all of it.
The Program
What Chronic Care Management actually requires
CCM is Medicare's original care-management program, launched in 2015. It pays your practice a monthly fee for coordinating care between visits for patients with two or more chronic conditions expected to last at least 12 months (or until death) that place the patient at significant risk of decline.
To bill it compliantly, every month you must deliver:
- A documented patient consent (verbal or written) before the first billed month
- An initiating visit for new patients or patients not seen in the last 12 months
- A comprehensive care plan — problems, goals, medications, interventions, care team — established, shared, and maintained
- 24/7 access to a member of the care team
- And the hard part: logged, auditable time. At least 20 minutes of clinical staff care-coordination time per calendar month, tracked to the minute.
The CCM code ladder
| Code | What it pays for | Monthly threshold | ~2025 rate* |
|---|---|---|---|
| 99490 | Clinical staff CCM, base | 20 min | ~$66 |
| 99439 | Add-on to 99490 (max 2/mo) | each +20 min | ~$50 |
| 99491 | Physician/QHP personal time | 30 min | higher than 99490 |
| 99487 | Complex CCM (care-plan revision + moderate/high MDM) | 60 min | ~$144 |
| 99489 | Add-on to complex CCM | each +30 min | ~$78 |
*National non-facility averages. Your locality and payer mix vary — our engine prices against your actual fee schedule.
The Problem
Why most CCM programs lose money — or never start
The economics of CCM fail on labor. A care manager can realistically run 150–250 patients when enrollment, monthly calls, documentation, and time-tracking are manual. At that ratio, the program barely covers its own staffing — which is why practices either never launch CCM, or hand it to an outsourced vendor that keeps 40–50% of the revenue and calls your patients from a call center that doesn't know them.
Meanwhile the money is real: a primary care provider with a typical Medicare panel leaves $100,000+ per year in CCM reimbursement uncollected.
How Sansera Runs It
An AI care team that does the work — your clinicians supervise
Finds every eligible patient.
Our AI reads your EHR problem lists, encounter notes, and claims history to surface patients with 2+ qualifying chronic conditions — including conditions documented in notes but missing from the problem list. Every AI-surfaced condition gets one-click provider confirmation before it counts.
Enrolls and consents them.
The Sansera voice agent calls, explains the program in the patient's language, captures verbal consent on a recorded line, and files the structured consent artifact. Ambiguous consents route to your staff — never auto-approved.
Drafts the care plan.
The AI assembles a CMS-compliant comprehensive care plan from the chart. Your provider edits and signs. No signed plan, no billing — the platform enforces it.
Runs the monthly check-in.
The AI Care Coach conducts structured, condition-specific monthly check-ins by voice or text — symptom review, medication adherence, barrier screening — documents a structured note, and escalates red flags to your RN on deterministic clinical rules you control.
Captures every minute automatically.
Calls, texts, chart review, and documentation time flow into an append-only, hash-chained time ledger. No timers, no spreadsheets. Every minute is allocated to exactly one program — double-counting is impossible by construction.
Bills the right code, every month.
At month close, the Smart Billing Engine walks the code ladder — base, add-ons, complex-CCM qualification (with provider MDM attestation) — validates against NCCI edits and program rules, and generates the claim with a full evidence bundle attached.
The Math
What CCM is worth on your panel
$317,000/year
A conservative example: 500 enrolled CCM patients × ~$66/month × 80% billable-month capture ≈ $317,000/year — before add-on codes, before complex CCM, and before stacking RPM on the same patients. Most practices running Sansera see $120K–$180K in new annual revenue per primary care provider across the full program stack.
For FQHCs
FQHC billing works differently, and we built for it: PPS/APM encounter logic, care-management billing under the current post-G0511 code structure, sliding-fee awareness, and UDS reporting integration are native — not bolted on.
FAQ
Chronic Care Management questions
Can we bill CCM and APCM together?
No. CCM, PCM, and APCM are mutually exclusive per patient per month. That's exactly why our Smart Billing Engine evaluates each patient monthly and selects whichever program pays more compliantly.
Who can perform the 20 minutes?
Clinical staff under general supervision of the billing practitioner for 99490/99439; the physician or QHP personally for 99491. Sansera tracks provider time and staff time separately so the right ladder applies.
Does the patient pay anything?
CCM carries standard Part B cost-sharing unless the patient has supplemental coverage or is a QMB (in which case cost-sharing is suppressed — our engine handles QMB logic automatically).
What happens if we don't hit 20 minutes on a patient?
Our forecaster predicts shortfalls by mid-month and schedules the outreach that closes the gap — so the month is saved before it's lost, not written off after.
SanseraCCM360™
One platform. Five programs. One right answer per patient.
CCM, PCM, and APCM are mutually exclusive — every patient, every month, there's one compliant program that pays best, and it changes as the patient changes. RPM and RTM stack on top with rules of their own. The Smart Billing Engine evaluates all of it monthly: eligibility, expected revenue, delivery requirements, and every compliance gate — deterministic rules, never AI guesswork, with an evidence bundle behind every claim.
Start with a working session, not a sales pitch.
Thirty minutes. Bring your panel size and payer mix; we'll show you what your care-management program is actually worth — and what it takes to capture it without hiring anyone.
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Human override on every autonomous decision