What is Chronic Care Management (CCM) Software?

Chronic Care Management (CCM) software is a HIPAA-compliant, cloud-based healthcare platform that helps healthcare providers deliver continuous, non-face-to-face care coordination for Medicare patients with two or more chronic conditions. It centralizes care plan management, patient communication, clinical documentation, and time tracking in a single system.

By automating time capture and generating Medicare-ready billing reports for eligible CPT codes, including 99490, 99491, and 99487, CCM software reduces administrative workload, improves documentation accuracy, increases patient engagement, and helps practices maximize Medicare reimbursement while delivering better patient outcomes.

Why Choose HumHealth Chronic Care Management Software

HumHealth provides a best-in-class, easy-to-use Chronic Care Management (CCM) software platform that helps healthcare organizations streamline patient enrollment, care coordination, clinical documentation, automated time tracking, and Medicare billing. Built for healthcare providers, our HIPAA-compliant platform simplifies care plan management, secure patient communication, automated documentation, and Medicare-ready billing reports, helping practices improve operational efficiency and maximize reimbursement. … Read More

For healthcare providers and care teams, HumHealth CCM software enables secure collaboration, personalized care plan management, two-way patient communication, clinical documentation, automated time tracking, and ongoing patient monitoring. By automating administrative tasks and capturing billable clinical time, providers can focus more on patient care while reducing manual documentation and improving operational efficiency.

For patients, HumHealth improves patient engagement by providing secure access to personalized care plans, educational resources, appointment reminders, and direct communication with their care team. This helps patients stay informed, adhere to treatment plans, and actively participate in managing their chronic conditions between office visits.

HumHealth’s built-in automated documentation timer accurately captures billable clinical time for eligible Chronic Care Management services. The platform supports Medicare CCM billing by tracking qualifying activities, documenting patient interactions, and generating audit-ready billing reports for eligible CPT codes, including 99490, 99491, and 99487, helping practices simplify compliance and improve reimbursement accuracy. Show Less

HumHealth Web App Features

HumHealth provides a seamless experience when it comes to chronic care management services. Some of the key features include comprehensive and personalized care plan for each patient, disease specific questionnaire for common chronic conditions, synchronization of patient self-assessment data from mobile app and current month status dashboard. The Continuity of Care Document (CCD) Upload and EMR Integration are also done at affordable pricing.

 
  • Personalized care plan for each patient

    Personalized care plan for each patient

  • Tracking Physician and Clinician time separately and Utilizing Optimal CPT code for billing

    Tracking Physician and Clinician time separately and Utilizing Optimal CPT code for billing

  • Two way communication with patient through Text Message

    Two way communication with patient through Text Message

  • Continuity of Care Document Upload and EMR Integration

    Continuity of Care Document Upload and EMR Integration

  • Feature to initiate video Call

    Feature to initiate Video Call

  • VOIP Integration with multiple vendors

    VOIP Integration with multiple vendors

  • HIPAA compliant Fax integration

    HIPAA compliant Fax integration

  • Synchronization of patient self-assessment data from Mobile app

    Synchronization of patient self-assessment data from Mobile app

  • Automated Time Tracker

    Automated Time Tracker

  • Define Care Team Members

    Define Care Team Members

  • Comprehensive Monthly Service Summary

    Comprehensive Monthly Service Summary

  • Comprehensive Scheduling Feature

    Comprehensive Scheduling Feature

  • CCM Current Month Status Dashboard

    CCM Current Month Status Dashboard

  • Customize Questionnaire for tracking Goals, Lifestyle Recommendations and Medications

    Customize Questionnaire for tracking Goals, Lifestyle Recommendations and Medications

  • Disease-specific questionnaire for common chronic diseases

    Disease-specific questionnaire for common chronic diseases

  • Questionnaire Configuration at facility and patient levels

    Questionnaire Configuration at facility and patient levels

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HumHealth Mobile App Features

  • Patient and Physician mobile app

    Patient and Physician mobile app

  • 24/7 access to care plan by patient

    24/7 access to care plan by patient

  • OTC Medication

    OTC Medication

  • Physical activity tracking

    Physical activity tracking

  • Record symptoms

    Record symptoms

Chronic Care Management
  • View the training session recording

    View the training session recording

  • View newsletter and educational material

    View newsletter and educational material

  • Calorie tracker

    Calorie tracker

  • Feature to attend a Video call

    Feature to attend a Video call

  • View call summary

    View call summary

HumHealth CCM Workflow

  • workflow 1

    1

    Identify Eligible Chronic Patients

    Clinicians identify eligible patients with chronic diseases using his/her patient list … Read More
  • workflow 2

    2

    Enroll The Patient

    On identifying the patients with two or more chronic conditions, the clinicians will enroll … Read More
  • workflow 3

    3

    Define A Care Plan

    Based on the patient’s health records, the Clinicians will formulate a suitable care plan … Read More
  • workflow 4

    4

    Monthly CCM

    The Clinician will have a monthly follow up call with the Patient to provide CCM service.
  • workflow 5

    5

    Track Time

    During the non-face-to-face interaction by a Clinician with the Patient, the … Read More
  • workflow 6

    6

    Timely Reimbursement

    Most would accept that the tedious part of CCM is getting a reimbursement … Read More

Chronic Care Management (CCM) CPT Codes and Average Reimbursement

We cover an extensive list of chronic care management billing codes that make up both complex and non-complex chronic care for Hospitals, Private practices, Rural Health Clinics (RHC), and Federally Qualified Health Centers (FQHC).

  • CPT 99490

  • Chronic care management services provided by clinical staff and directed by a physician or other qualified health care professional (Non-Complex)
  • Duration 20 minutes

  • $66

  • CPT 99439

  • Add-on code – first increment (non-complex CCM)
  • Duration 20 minutes

  • $50

  • CPT 99491

  • Chronic care management services, provided personally by a physician or other qualified health care professional
  • Duration 30 minutes

  • $89

  • CPT 99437

  • Add-on Code for Chronic Care Management services, provided personally by a physician or other qualified health care professional
  • Duration 30 minutes

  • $63

  • CPT 99487

  • Complex Chronic care management services provided by clinical staff and directed by a physician or other qualified health care professional
  • Duration 60 minutes

  • $144

  • CPT 99489

  • Add-on code for Complex CCM Service
  • Duration 30 minutes

  • $78

*Reimbursement rates are based on a national average and may vary depending on your location. Check the Physician Fee Schedule 2026 for the latest information.

HumHealth is unmatched in its field when it comes to pricing transparency. Our plans are flexible, we are clear on the different options available to you based on your budget. We understand that doing research on pricing takes up a lot of time, and thus have made everything transparent when it comes to browsing different price options to figure out the right fit. Our goal is to provide a delightful onboarding experience so your team and your patients can start realizing the benefits of a chronic care program. … Read More

At a time when the world shifts to value-based remote care, we are on standby to support any healthcare organization set up and run their Chronic Care Management operations. Chronic care fits well with other types of reimbursable programs mentioned in our website. If you have any questions, please do email us or use the chat feature. If you are ready to get started, please sign up for a demo. Show Less

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What Our Clients Say About HumHealth CCM

I am a solo practitioner, internist, and I started using HumHealth for CCM care about one year ago. I had previously used, a CCM program that was integrated with my previous EMR. I found that the costlier programs still involved having to enter CCM minutes, as “structured data”.
With HumHealth, I just enter minutes directly into that program. My overhead was decreased substantially, and I have more than doubled my CCM minutes, and billable CCM patients. Support is great. This is a simple effective program and I highly recommend HumHealth for CCM management.

Dr. Javier A Valadez

Internist

Sunset Clinic PA, Dallas, TX

HumHealth has been a great addition to my Internal Medicine practice. The program has allowed me to extend my office beyond the physical walls and into the virtual realm.
The RPM program allows me to reliably track my patient’s vitals by proving real time useful data. The CCM module allowed me to keep in contact with patients who were chronically ill and needed more supportive care. The programs were tremendous at helping me keep my patients safe and healthy during the COVID lockdown and providing a supplemental source of income.
The products are User friendly and it is easy to teach staff how to use. The HumHealth customer service is easy to contact and very helpful at resolving any issues that arise.

Howard E. Anderson II, M.D.

Physician/Owner

Anderson Medical Group of Texas, PLLC, Dallas, TX

Chronic Care Management FAQs

Chronic Care Management (CCM) software helps healthcare providers manage Medicare patients with two or more chronic conditions.
It automates time tracking for billable CCM activities, centralizes care plan creation, and enables non-face-to-face communication between clinicians and patients.
At month-end, it generates Medicare billing reports for CPT codes 99490, 99491, and 99487, helping practices receive reimbursement without manual documentation.

The best Chronic Care Management (CCM) software offers automated patient monitoring, care plan management, billing support, automated time tracking, patient communication tools, and compliance with CMS guidelines.
Providers should look for scalability, ease of use, strong reporting capabilities, and CMS-compliant workflows.
Learn how the HumHealth CCM platform simplifies chronic care management workflows.

The best CCM software should include automated time tracking, personalized care plan templates, two-way patient communication (phone, text, video), a patient mobile app, HIPAA-compliant messaging, CPT code optimization for billing, and a real-time dashboard showing each patient’s monthly CCM progress and billing status.
Support for both non-complex and complex CCM is essential for practices with diverse Medicare populations.

CCM software supports management of any condition qualifying under CMS guidelines — conditions expected to last at least 12 months or until death. Common conditions include diabetes, hypertension, heart disease, COPD, chronic kidney disease, depression, asthma, and Alzheimer’s disease.
HumHealth includes condition-specific questionnaires and care plan templates for the most common chronic conditions, enabling faster and more consistent care plan creation.

CCM software focuses on care coordination and communication for chronic patients, while Remote Patient Monitoring (RPM) software collects and monitors patient health data remotely through connected medical devices.

The CMS care plan must include a problem list of chronic conditions, expected outcomes and disease course, measurable treatment goals, symptom management strategies, planned interventions and regular follow-ups, medication management, a care coordination plan between provider and patient caregivers, and requirements for periodic review and revision.
HumHealth generates care plans that meet all CMS documentation requirements, with electronic copies available for patients.

Revenue depends on enrolled patients and CPT codes billed. At national average rates: 99490 pays ~$66/patient/month , 99491 pays ~$89 , and CPT 99487 (complex CCM) pays ~$144.
 A practice with 200 enrolled patients billing CPT 99490 may generate approximately $13,200/month in additional Medicare revenue. Add-on codes 99439, 99437, and 99489 provide further incremental reimbursement beyond these base amounts.
CMS Physician Fee Schedule 2026

To bill CPT 99490 (non-complex CCM), a minimum of 20 minutes of qualifying clinical staff time must be documented per patient per calendar month. CPT 99491 requires 30 minutes of physician-directed time.
Complex CCM (CPT 99487) requires 60 minutes with moderate-to-high complexity decision-making. HumHealth’s automated timer captures every qualifying minute accurately, helping reduce under-billing commonly associated with manual time tracking.
CMS CCM Billing Requirements

Yes. HumHealth supports both Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) within a single integrated platform. Patients with chronic conditions frequently qualify for both programs simultaneously.
Using one platform eliminates data silos, reduces staff training overhead, and simplifies multi-program billing.
HumHealth also supports RTM , PCM , APCM , AWV , BHI , and other Medicare-reimbursable programs — making it a comprehensive chronic care management platform rather than a single-program solution.
Schedule a demo to see how HumHealth simplifies multi-program care management.

HumHealth stands out for its predefined care plan templates, automated time tracking, transparent pricing, native support for both complex and non-complex CCM, billing support reports, a full-featured patient mobile app, and high ratings on Capterra, GetApp, and Software Advice. It combines comprehensive CCM functionality with ease of use, making it accessible for practices of any size without requiring extensive technical training.
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Medicare patients with at least two or more chronic conditions that are expected to be present for at least 12 months or until the patient’s death are eligible for the CCM program.
CMS CCM Eligibility Requirements

Regular CCM covers 20 minutes of clinical staff time per month for ongoing oversight, management, and care planning. Complex CCM applies to patients at significant risk of death and requires a minimum of 60 minutes of clinical staff time, substantial revision of care planning, and moderate-to-high complexity medical decision making.
All CCM services must be provided under physician or non-physician provider supervision.
Review official CMS CCM requirements.

Yes. CCM and RPM can typically be billed together when CMS requirements for both programs are met and services are properly documented.

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