Medicare Chronic Care Management Program

Proactive Patient Care & Higher Reimbursements Made Easy

Add value-based care for Medicare patients and increase revenue through easy & risk-free process integration.  

Become Known As the Healthcare Hero

Be the hero of patients’ health stories with Neolytix’s Medicare Chronic Care Management support. Every addition to how you provide healthcare to your patients helps you stand out from your competitors. With our Rev+ Patient Chronic Care Management Program, you can enjoy an improved reputation as well as an increase in reimbursements by harnessing the expertise of our teams and their industry-leading technology to provide round-the-clock monitoring of your most vulnerable patients’ health.

Improve Patient Perception of Your Practice

Medicare Chronic Care Management services allow you to keep track of your patient’s well-being around the clock. By introducing this new type of proactive care to patients, they will sing your praises and grow their trust in your practice’s ability to provide excellent healthcare, even from the comforts of their own homes.
Be Rewarded for Your Heroics
By embracing Medicare Chronic Care Management with Neolytix, healthcare providers can tap into an additional revenue stream. Through reimbursable care coordination services, providers not only elevate patient well-being but also boost financial growth, fostering a win-win partnership for better health and financial prosperity.

Be a Leader, Not a Lagger

With the Remote Patient Monitoring (RPM) market set to continue its health growth rate of 26.7% until the end of the decade, it’s clear to see that telehealth and remote monitoring will become a standard expectation of patients when it comes to value-based care. For now, not many patients are familiar with the concept- especially older patients. Seize this opportunity to introduce the service to them, before your competition does.

A Win-Win Partnership for Better Health and Financial Prosperity

Medicare Chronic Care Management offers a platform that enables practices to maintain continuous awareness of their patient’s status, leading to a significant enhancement in patient care. But the benefits extend toward the provider side, too, because healthcare providers can access extra risk-free revenue without requiring additional resource investments.


Personalized Wellness Support

Our service promotes proactive management of chronic conditions for improved overall well-being.

Enhanced Accessibility:

Patients’ vitals are tracked round-the-clock, fostering peace of mind and timely interventions whenever health concerns arise.

Empowered Self-Management:

Through educational resources and close monitoring, patients are empowered to take control of their health, leading to better health outcomes and improved quality of life.


Steady Revenue Stream:

Healthcare providers can expand their revenue through reimbursable chronic care coordination services, adding a consistent source of income to their practice.

Streamlined Workflow:

Our service streamlines patient data collection, enabling efficient care coordination and reducing administrative burdens, allowing healthcare providers to focus more on patient care.

Stronger Patient Engagement:

Providers can foster deeper patient relationships and loyalty by offering extended care support, resulting in improved patient satisfaction and a strong reputation within the community.

How Does It Work?

The benefits to both patients and providers become very clear when we start considering the numbers. Let’s have a look at how both sides of the service can benefit.

Improved Health

Chronic Care Management refers to the remote monitoring and support of Medicare beneficiaries above the age of 65, who have multiple (two or more) chronic health conditions.

Healthcare providers utilize our CCM program to coordinate and monitor patients’ health, medication adherence, and lifestyle adjustments, which leads to an improvement in patient health. For their services, healthcare providers are reimbursed accordingly.

Improved Revenue

CPT code 99490 is a healthcare billing code used for chronic care management (CCM) services. This code is used to bill for non-face-to-face care coordination services provided to patients with multiple (two or more) chronic conditions, expected to last at least 12 months or until death.

New Monthly Revenue QUICK Calculation:

Follow the steps below to get a ballpark figure for new reimbursements.

  1. Determine the number of Medicare patients you have
  2. Take this number and multiply by 0.67
  3. Multiply the answer by $64.02

Why Delegate Care to Neolytix Rev+?

Rev+ CCM Program seamlessly integrates with your current operations and health systems to deliver Chronic Care Management and Remote Patient Monitoring services without requiring upfront investments, staff training, and operational hiccups. Our exclusive focus on the healthcare industry for over 11 years gave us the expertise to collaborate harmoniously with practice teams.

access instant expertise

Access Instant Expertise

We bring the tech and process expertise that assists with seamless CCM solutions integration.

white glove service

White-Glove Service

Round-the-clock simplified billing, technical & end-user support.

risk free collaboration

Risk-Free Collaboration

No upfront investment for CCM, software, hiring staff, and training.

years of experience

11+ Years Experience

Providing Non-Clinical Care to Practices of All Sizes 


Constant Monitoring

Monitoring, recording, and reporting health data every hour of every day and year.

50 states

50 States

Offering CCM Services and other non-clinical services, nationwide


Speak to a Specialist

Schedule a FREE consultation with one of our specialists to learn how Revenue+ can empower Chronic Care Management to expand patient care and optimize reimbursement revenue.

EHR Integration with Rev+ Medicare
Chronic Care Program

Regardless of your EHR system, Neolytix Rev+ RPM & CCM integrates flawlessly into all of the EHRs in the country, like Epic, Athena, eCW, Cerner, etc.
EHR RPM Integration

The information will be fed into the EHRs, and the upload process will be dependent on the EHR integration, affecting the timing and speed of the transfer.

A PDF can be regenerated as needed, incorporating all new additional notes and information. As administrators, we have access to these updated reports. Providers may not have direct access to the patient PDFs unless they are directly fed into the EHR records. The ability to upload the updated reports will depend on the EHR system in use.

Readings are included in the patient’s PDF report along with notes, alerts, transmissions, time tracking, and patient information. The patient’s PDF report provides a summary of the readings and an overall view of each reading they took.

From the medical billing side for RPM, Neolytix handles the billing and takes extra care because if we don’t get reimbursements, we can’t charge our clients as in accordance with our RPM policy.

Reimbursement Calculator

Simply enter a ‘guestimation’ of the patients that must utilize their RPM device daily

Speak to a Specialist

Schedule a FREE consultation with one of our specialists to learn how Revenue+ can empower Chronic Care Management to expand patient care and optimize reimbursement revenue.


How others benefited from working with Neolytix

Sue Robbins
Sue Robbins
Neolytix has helped so much with our outstanding A/R. They are always so very willing to help and complete the task in a timely manner.
We transitioned to Neolytix a while back, having come from a billing company we were less than thrilled about. The people here have been very responsive to our needs and requests, and adapt quickly to whatever curve balls our practice throws them. They bring a wealth of knowledge to the table, and take the attitude that our success is their success.
Sandy M
Sandy M
I was a new office manager for a private practice when I hired Neolytix for credentialing assistance. Eden has been very thorough and helpful every step of the way. insurance credentialing can be so overwhelming at times, that having this task off my plate has given me a peace of mind. I know she is handling everything. Always quick to respond to questions or concerns.
Cheryl Lambert
Cheryl Lambert
Neolytix is the most professional and hard working billing company I have ever been partners with . I call them a partner because they truly are. Neolytix makes sure what they bill is accurate. Their knowledge of physician billing is outstanding. The entire team takes control and does what is necessary to make sure you get paid.
Priti Patel
Priti Patel
I habe hired a virtual assistant through Neolytix and she is amazing. The team has trained her well so I didn't have to deal with that aspect so I can focus on running my clinic. She is fast and responsive to clinic tasks. Patients have said positive things about her as well.The team at Neolytix did well...I just wish I would have signed up sooner 😅

Frequently Asked Questions (FAQ’s)

Chronic care management services refer to services that are not provided in person, but rather are offered to Medicare beneficiaries with at least two chronic conditions that are expected to last for a minimum of 12 months or until the patient’s death.

The Centers for Medicare & Medicaid Services (CMS) acknowledges the importance of CCM services as fundamental elements of primary care that enhance wellness and lower healthcare expenditures.

Implementing Medicare Chronic Care Management services can provide several benefits for both patients and healthcare providers. Some reasons why Medicare CCM may be beneficial include:

  1. Improved patient outcomes CCM services are designed to help patients manage their chronic conditions and promote better health outcomes. By providing regular check-ins, care coordination, and support, CCM services can help patients avoid complications, reduce hospitalizations, and improve their overall quality of life.
  2. Increased revenue for healthcare providers: By providing CCM services, eligible healthcare providers can receive reimbursement from Medicare, which can help increase their revenue streams. Additionally, providing CCM services can help improve patient satisfaction and loyalty, leading to increased business for the healthcare provider.
  3. Reduced healthcare costs: By helping patients better manage their chronic conditions, CCM services can help reduce healthcare costs associated with hospitalizations, emergency department visits, and other expensive treatments. This can help lower overall healthcare expenditures for both patients and payers.
To qualify for chronic care management (CCM) services, a Medicare beneficiary must have at least two chronic conditions that are expected to last for at least 12 months or until the patient’s death. Examples of chronic conditions that may qualify for CCM services include diabetes, heart disease, hypertension, chronic obstructive pulmonary disease (COPD), asthma, arthritis, dementia, depression, and cancer, among others. 

These physicians and Non-Physician Practitioners (NPPs) may bill CCM services:

  • Physicians
  • Certified Nurse Midwives (CNMs)
  • Clinical Nurse Specialists (CNSs)
  • Nurse Practitioners (NPs)
  • Physician Assistants (PAs)

They must also have an established relationship with the patient and must use an electronic health record (EHR) system that meets certain requirements to document and report the CCM services. Take note of the different codes used for billing between NPPs and physicians.

CPT code 99491: Time only the billing practitioner spends. Clinical staff NPPs’ time doesn’t count.

CPT codes 99487, 99489, and 99490: Time spent directly by NPPs. Practitioner time is also allowed if not billed under 99491 already.

Medicare reimburses for Chronic Care Management (CCM) services on a monthly basis, meaning that eligible healthcare providers can receive payment for each month that they provide CCM services to an eligible patient. It’s important to note that Medicare may also reimburse for additional services provided in conjunction with CCM, such as transitional care management, advance care planning, and annual wellness visits, among others. However, the reimbursement rates for these services may differ from that of CCM services. The rates below are based on national averages.

The CPT codes used to report CCM services are:

  • CPT code 99437 $49.98
    30 additional minutes of provider time (no limit)
  • CPT code 99439 ($47.44)
    Each additional 20 minutes of clinical staff time spent providing non-complex CCM directed by a physician or other qualified health care professional (billed in conjunction with CPT code99490)
  • CPT code 99490 ($62,69)
    Non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability.
  • CPT code 99491 $85.06
    CCM services are provided personally by a physician or other qualified health care professional for at least 30 minutes.
  • CPT code 99487 $133.18
    Complex CCM is a 60-minute timed service provided by clinical staff to substantially revise or establish comprehensive care plan that involves moderate- to high-complexity medical decision-making.
  • CPT code 99489 $70.49
    Is each additional 30 minutes of clinical staff time spent providing complex CCM directed by a physician or other qualified health care professional (report in conjunction with CPT code 99487; cannot be billed with CPT code 99490)
Coordinated care transcends the realm of a conventional office visit, especially within the context of Medicare Part B services. While office visits offer essential healthcare interactions, coordinated care delves deeper. It involves proactive strategies to address chronic conditions, minimize acute exacerbation and decompensation, and prevent functional decline. By extending the focus beyond routine appointments, coordinated care under Medicare Part B seeks to enhance patient well-being and quality of life, even as it navigates the sensitive aspects surrounding the eventual passing of the patient.

Schedule a free, no-obligation consultation to learn more about optimizing your revenue cycle

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