Outcomes-based payment for technology-enabled chronic care management during a follow-on period

This HCPCS code represents an outcomes-based reimbursement model for remote, technology-facilitated chronic care management (CCM) services. Unlike traditional time-based CCM codes, this code ties payment to measurable patient health outcomes rather than minutes of care coordination delivered. It is designed for patients with multiple chronic conditions receiving ongoing care management through digital health platforms or remote monitoring technologies.

Apply this code when a qualified provider delivers CCM services through a technology-enabled platform under a payer contract structured around outcome-aligned payment (OAP) methodology. This code is most relevant in value-based care arrangements, accountable care organizations (ACOs), or payer-specific programs that have adopted OAP frameworks for chronic disease management. Supporting documentation should include evidence of the technology platform used, the chronic conditions being managed, and the outcome metrics tied to the payment arrangement.

• This code is not interchangeable with CPT-based CCM codes (e.g., 99490, 99491, 99487); verify the payer contract explicitly supports OAP methodology before billing, as this is not universally recognized across all payers.
• Avoid duplicate billing with standard time-based CCM or remote physiologic monitoring (RPM) codes for the same service period, as this may constitute unbundling.
• Documentation must clearly reflect the outcome measures being tracked and the technology platform facilitating care, as payers utilizing this code will likely require outcome reporting as a condition of payment.