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. Medicare covers CCM federally for patients with 2+ chronic conditions. PA Medicaid provides full supplementary coverage. CCN Health manages the clinical workflows, care plan documentation, and monthly billing for Pennsylvania organizations running CCM programs.
Medicare Billing
CCM billing in Pennsylvania.
CCM uses federally standardized CPT codes with uniform reimbursement across Pennsylvania. PA Medicaid provides full 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 full 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
Regulatory Landscape
CCM compliance in Pennsylvania.
Beyond federal Medicare requirements, Pennsylvania has specific telehealth, licensure, and privacy regulations that affect CCM programs.
Telehealth Parity
- *Pennsylvania has telehealth parity legislation requiring CCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Pennsylvania joined the Interstate Medical Licensure Compact. Telehealth parity established for most services.
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.
CCN Health integrates with leading EHR platforms used by Pennsylvania providers. Each integration includes automated CCM documentation, billing, and clinical workflows.
PointClickCare
889 integration guides
ALIS
887 integration guides
Ethizo
240 integration guides
athenahealth
240 integration guides
Charm Health
240 integration guides
MatrixCare
240 integration guides
Epic
240 integration guides
August Health
240 integration guides
FAQ
CCM in Pennsylvania questions.
CCM in Pennsylvania uses Medicare CPT codes 99490, 99491, 99439. These are federal codes with uniform reimbursement nationwide, generating ~$80-$130/mo per patient per enrolled patient per month.
PA Medicaid provides full supplementary coverage for CCM services. Medicare covers CCM federally for patients with 2+ chronic conditions. PA Medicaid provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Pennsylvania has telehealth parity legislation requiring CCM services to be reimbursed at equivalent rates compared to in-person visits. Pennsylvania is a member of the Interstate Medical Licensure Compact, facilitating cross-state CCM delivery. Pennsylvania joined the Interstate Medical Licensure Compact. Telehealth parity established for most services.
Patients in Pennsylvania qualify for CCM if they have two or more chronic conditions expected to last at least 12 months, such as hypertension, diabetes, COPD, heart failure, or CKD. Each qualifying condition must place the patient at significant risk of death, acute exacerbation, or functional decline.
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.
CCN Health helps Pennsylvania providers launch CCM in three steps: (1) Discovery — we assess your EHR, workflows, and patient population; (2) Launch — devices ship to patients, data flows into your EHR automatically; (3) Scale — expand enrollment and add programs as your CCM census grows. Most practices begin billing within 2-4 weeks.
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.