Chronic Care Management in Pennsylvania.
Non-face-to-face care coordination for patients with multiple chronic conditions. Medicare billing, PA Medicaid coverage, and compliance details for Pennsylvania providers.
How does CCM work for providers in Pennsylvania?
Chronic Care Management (CCM) enables Pennsylvania providers to bill Medicare for non-face-to-face care coordination using CPT codes 99490, 99491, 99439. Patients with two or more chronic conditions qualify — common combinations in Pennsylvania include heart disease, diabetes, COPD. Medicare covers CCM federally for patients with 2+ chronic conditions. PA Medicaid provides partial supplementary coverage. Serving 2.5M seniors with +12% by 2035 projected growth, Pennsylvania's CCM market is expanding. CCN Health manages clinical workflows, care plan documentation, and monthly billing — integrating with 5+ major health systems including UPMC and Penn Medicine running CCM programs. As an Interstate Medical Licensure Compact member, Pennsylvania facilitates cross-state CCM delivery.
Medicare Billing
CCM billing in Pennsylvania.
CCM uses federally standardized CPT codes with uniform reimbursement across Pennsylvania. PA Medicaid provides partial supplementary Medicaid coverage for dual-eligible patients.
CCM services, first 20 min of clinical staff time per month
CCM services requiring physician/QHP, first 30 min/month
Each additional 20 min of CCM clinical staff time
~$80-$130/mo per patient
20 minutes of non-face-to-face care coordination per month (99490); 30 minutes for complex CCM (99491)
Medicare covers CCM federally for patients with 2+ chronic conditions. PA Medicaid provides partial supplementary coverage.
Billing Requirements
Patient must have two or more chronic conditions expected to last at least 12 months
Comprehensive care plan must be established and maintained
Patient consent documented in medical record
24/7 access to care team required
Continuity of care with designated practitioner
Pennsylvania Medicaid Supplement
PA Medicaid provides partial supplementary coverage — check current PA Medicaid fee schedules for dual-eligible CCM rates.
Pennsylvania-Specific Billing Considerations
Pennsylvania telehealth registration requirements
Regulatory Landscape
CCM compliance in Pennsylvania.
Beyond federal Medicare requirements, Pennsylvania has specific telehealth, licensure, and privacy regulations that affect CCM programs.
Interstate Licensure
- *Pennsylvania is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide CCM services across state lines.
Additional Requirements
- *Pennsylvania telehealth registration requirements
EHR Integrations
CCM-compatible EHRs.
Major Pennsylvania health systems like UPMC and Penn Medicine use EHR platforms that CCN Health integrates with. Each integration includes automated CCM documentation, billing, and clinical workflows.
PointClickCare
665 integration guides
ALIS
663 integration guides
MatrixCare
663 integration guides
August Health
663 integration guides
Ethizo
240 integration guides
athenahealth
240 integration guides
Charm Health
240 integration guides
Epic
240 integration guides
FAQ
CCM in Pennsylvania questions.
Pennsylvania's mix of urban centers and rural communities means CCM serves both high-volume practices affiliated with systems like UPMC and Penn Medicine and remote clinics where in-person visits are difficult. PA Medicaid offers partial supplementary coverage for dual-eligible patients. Pennsylvania's membership in the Interstate Medical Licensure Compact enables cross-state CCM delivery. High prevalence of heart disease, diabetes, COPD among Pennsylvania's patient population drives CCM enrollment.
PA Medicaid provides partial supplementary coverage for CCM services. Medicare covers CCM federally for patients with 2+ chronic conditions. PA Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
With 2.5M residents aged 65+, Pennsylvania has a large CCM-eligible population — patients with two or more chronic conditions. Common multi-morbidity combinations in Pennsylvania include heart disease with diabetes, and COPD with heart disease. Pennsylvania's +12% by 2035 senior population growth means CCM demand is accelerating. Pennsylvania's high Medicare Advantage penetration means many seniors are already enrolled in plans that support CCM.
Pennsylvania has approximately 2.5M residents aged 65+ (19.4% of the population), with +12% by 2035 projected growth. Mature healthcare market with strong academic medical centers. Significant rural population benefits from telehealth. UPMC and Geisinger are leaders in value-based care.
CCM in Pennsylvania must comply with federal Medicare billing requirements and HIPAA. Pennsylvania does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. As an Interstate Medical Licensure Compact member, Pennsylvania allows compact-licensed physicians to deliver CCM services across state lines. Additional Pennsylvania-specific requirements include: Pennsylvania telehealth registration requirements. Pennsylvania joined the Interstate Medical Licensure Compact. Telehealth parity established for most services.
This page provides general informational guidance only and does not constitute legal, compliance, or billing advice. Telehealth regulations, Medicaid coverage, and state privacy laws change frequently. Verify current requirements with your state health department, payers, and qualified healthcare compliance counsel before making program decisions. Demographic data is based on U.S. Census Bureau estimates. Data last verified: March 2026.
Other Programs
More programs in Pennsylvania.
Explore other Medicare remote care programs available to Pennsylvania providers.
RPM
Remote Patient Monitoring
Real-time vital sign monitoring with FDA-cleared cellular devices.
PCM
Principal Care Management
Focused management of a single high-complexity chronic condition.
BHI
Behavioral Health Integration
Behavioral health screening and collaborative care in primary care settings.
RTM
Remote Therapeutic Monitoring
Therapy outcome monitoring for musculoskeletal and respiratory rehabilitation.