Is there a time when a patient covered by CCM is not eligible for the service?

Yes. There are four types of services that cannot overlap with CCM services on the same day, as some services provided in the care management component may be provided by another service.

CPT code 99490 cannot be billed during the same service period as CPT codes 99495– 99496 (transitional care management), Healthcare Common Procedure Coding System (HCPCS) codes G0181/G0182 (home health care supervision/hospice care supervision), or CPT codes 90951–90970 (certain End-Stage Renal Disease services). Also consult CPT instructions for additional codes that cannot be billed during the same service period as CPT code 99490. There may be additional restrictions on billing for practitioners participating in a CMS sponsored model or demonstration program.