Medicare pays chronic care management and principal care management as calendar-month services, counted in time and billed by one practitioner. Consent, an initiating visit, and a care plan have to be in the chart before the first claim goes out.
Book a demoCMS sets the rules in its chronic care management booklet. Three of them decide most claims.
Clinical staff time bills as 99490 for the first 20 minutes, with 99439 for each added 20. Practitioner time uses 99491 and 99437, and complex CCM uses 99487 and 99489. Non-complex and complex CCM can't both be reported for one patient in the same month.
New patients, and patients not seen in the past year, need an initiating E/M visit, annual wellness visit, or IPPE where CCM was discussed. Written or verbal consent, covering cost sharing and the right to stop, must be documented before billing.
PCM covers one high-risk chronic condition expected to last at least 3 months, billed with 99424 through 99427. CMS won't pay PCM for less than 30 minutes in a calendar month.
Care managers, providers, and billing each own a piece of the month. The claim only works when the time log reaches billing clean.
Your care team keeps patient outreach, the electronic care plan, 24/7 access, and the time log. The physician approves the codes before anything is submitted.
Taiga drafts codes from the notes, checks eligibility, scrubs and submits the monthly claims, and works every denial and appeal, including small-dollar monthly claims that are easy to write off.
Overlap rules need an owner: TCM in the same month, remote monitoring, home health or hospice supervision codes, and patients who may have switched to another CCM practitioner.
Bring a de-identified monthly time log, a paid CCM claim, and a denied one. Keep patient details out of the booking form.
Share rough monthly CCM and PCM volume, and how many patients are complex.
Describe whether nurses, medical assistants, or providers do the work and where the time is recorded.
CMS now pays advanced primary care management as a monthly bundle without minute counts. Say whether you bill it or plan to, since it changes which codes apply.
A good match for a primary care or internal medicine practice that already enrolls patients in CCM or PCM and loses claims to missing consent, overlap edits, or unworked denials.
Taiga does not run outreach calls, staff a 24/7 line, or decide which patients qualify. This page summarizes CMS guidance and is not a coverage determination.
Yes, with limits. CMS lets you report 99490, 99491, 99487, and 99489 during the 30-day TCM period, as long as no time is counted toward more than one code.
Clinical staff time counts when provided under the billing practitioner's direction, subject to state law, scope of practice, and incident-to rules. Whether a medical assistant qualifies depends on CPT's clinical staff definition and your state.
No. CMS requires informed consent once, unless the patient moves to a different CCM practitioner. Document it in the chart before the first claim.
Yes. CMS allows either RPM or RTM concurrently with CCM or TCM, but not both, and the same minutes can't count twice.
Show Taiga how many patients you enroll, how time is logged, and where claims stall. You will hear plainly what Taiga would take on.
System guides show possible billing handoffs, not proven specialty compatibility.