“Money Left on the Table”: How to Capture Untapped Medicare Revenue Through CCM (CPT Codes 99490 & 99439)

Story by Connor Danielowski / November 17, 2025

Most healthcare organizations don’t have a revenue problem, they have a capture problem.

Every month, practices across the U.S. leave tens of thousands of dollars in unclaimed Medicare revenue sitting in plain sight. The culprit isn’t lack of opportunity. It’s lack of a fully operational Chronic Care Management (CCM) program that properly tracks time, documents care, and bills consistently.

If your practice treats Medicare patients with two or more chronic conditions, CCM is not just a clinical enhancement. It’s one of the most reliable recurring-revenue engines available in value-based care today.

This guide breaks down where the “leftover money” hides, and how you can capture it using CPT codes 99490 and 99439.

Why So Many Practices Miss Out on CCM Revenue

Chronic Care Management is one of the only Medicare programs that pays every single month, with no visit required. Yet most practices only capture a fraction of what they qualify for.

The most common revenue leaks include:

• Unenrolled eligible patients (many practices enroll <10% of those who qualify)
  
• Insufficient time tracking or failure to hit the 20-minute threshold
  
• Lack of consistent monthly outreach
  
• Inadequate documentation for CMS audit standards
  
• Underbilling the add-on code (99439)
  
• Staffing shortages causing inconsistent follow-up
  

A well-run CCM program can immediately convert these missed opportunities into predictable revenue.

The Revenue Potential of CCM (CPT Codes 99490 & 99439)

CPT 99490 – Base CCM Code

• 20 minutes of non-face-to-face care per month
  
• Average national reimbursement: $60 per patient per month
  

CPT 99439 – Add-On Code

• Each additional 20 minutes of documented care
  
• Average reimbursement: $45 per patient per month
  
• Billable twice, meaning a single patient can generate up to three reimbursable events per month.
  

Real-World Example: Monthly Revenue Often Left on the Table

Most healthcare organizations severely underestimate how much CCM revenue they’re missing. Below are two standardized scenarios—using the same patient counts used elsewhere—to show what “unclaimed revenue” truly looks like.

Scenario: Smaller Practice (200 Eligible Medicare Patients)

Typical enrollment today (20-30%): 40-60 patients
Current monthly revenue:

• 40 × $60 = $2,400/month
  
• 60 × $60 = $3,600/month
  

Realistic achievable enrollment (50-60%): 100-120 patients
Full CCM revenue opportunity:

• 100 × $60 = $6,000/month
  
• 120 × $60 = $7,200/month
  

Add-on codes (conservatively):
→ +$2,500-$4,000/month

Total potential monthly revenue:
→ $8,500 – $11,200/month
Annual potential:
→ $102,000-$134,400/year

Most small practices capture less than one-third of that.

CCM Creates Revenue and Competitive Advantage

Yes, CCM generates recurring reimbursement, but the financial benefits go far deeper:

1. Higher Patient Retention & Better Outcomes

Consistent monthly engagement reduces patient leakage and improves quality scores.

2. Stronger Value-Based Contracting Position

Better chronic disease control = more favorable payer negotiations.

3. Predictable Monthly Revenue

CCM becomes a stable cash-flow foundation that supports staffing, expansion, and innovation.

4. Operational Efficiency Through Outsourcing

Practices using Chronic Care Staffing instantly gain a trained CCM workforce without adding payroll costs, training time, or administrative burden.

Where Most Practices Lose Money and How to Fix It

Problem 1: Low Enrollment

Most organizations never enroll 60-80% of eligible patients.

Fix:
Use outreach teams trained in high-success CCM enrollment scripts and compliance language.
(Our average partner reaches 65-75% enrollment.)

Problem 2: Missing Documentation

CMS audits require precise:

• Time logs
  
• Care plan updates
  
• Monthly patient touches
  
• EMR documentation in real time
  

Fix:
Automate time tracking and centralize documentation through a CCM-trained support team.

Problem 3: Add-On Code Underbilling

Most practices never bill 99439, even when they easily qualify for it.

Fix:
Track additional touches across RN calls, medication coordination, care plan adjustments, specialist referrals, and more.

Problem 4: Staff Fatigue

Front-office teams are too overloaded to maintain 20-60 minutes of monthly care management per patient.

Fix:
Outsource the entire CCM workflow so clinical staff can focus on in-office and acute needs.

What a Fully Managed CCM Program Looks Like

A high-performing CCM program, like the ones run through Chronic Care Staffing, includes:

• Patient outreach and enrollment
  
• Monthly telephonic or digital check-ins
  
• Medication review and reconciliation
  
• Care plan creation and updates
  
• Specialist coordination
  
• Social determinant assessments
  
• Documentation + time tracking
  
• Monthly billing support
  
• Audit-ready EMR entries
  

This system eliminates revenue leakage and ensures Medicare compliance while generating steady revenue.

The Bottom Line: CCM Revenue Isn’t Extra, It’s Already Yours

If you’re treating Medicare patients, CCM revenue is not a stretch goal- it’s built into the reimbursement system. You simply need a structured program that captures what CMS has already allocated.

Most practices are sitting on six figures in unclaimed revenue each year.
The practices that win in 2025-2026 will be those that close the gap between eligibility and capture.

Chronic Care Staffing makes that transition turnkey. Contact us today to learn more.

Categories: Chronic Care Management News