What has to be true to bill CCM this month.

These codes pay your clinic for its own care-management time, so no FDA device is required. MARKABLE stays a general-wellness documentation and efficiency layer: it presents the patient's data and structures the record, and every clinical decision stays with your clinician. Tick every box below for a given patient and the month is billable. (Click a box to check it.)

Set up once, per patient

One time

2+ qualifying chronic conditions documented.

Each active, expected to last 12 months or more, at significant risk. E.g. osteoporosis + depression. Never menopause itself.

Comprehensive care plan in the certified EHR, with a copy given to the patient.

Patient consent on file, once, including the cost-sharing disclosure and the right to stop.

Initiating visit completed for a new patient or one not seen in 12 months (E/M, annual wellness, or IPPE).

Confirm every month to bill

Each calendar month

20+ minutes of care-management time, by a physician/QHP or clinical staff under general supervision, contemporaneously logged.

Counts: reviewing the trend, medication reconciliation, coordinating with other providers, revising the plan, patient/caregiver contact. Does not count: the patient's own time, scheduling, admin.

Care plan reviewed and revised based on the month's data.

At least one care-coordination or patient touch, and 24/7 access to the care team is available.

Only this practice bills CCM this patient this month, no CCM + PCM together, and no minutes double-counted against an office visit.

All boxes ticked → bill CCM 99490 (first 20 min, ~$66). Add 99439 (~$50) per extra 20 minutes actually logged, and G2211 (~$16) on the office E/M for the longitudinal relationship.

PCM variant — for an OB-GYN or specialty menopause clinic

One serious/complex condition instead of two (osteoporosis is safest; refractory vasomotor symptoms needing frequent HRT titration is a stretch, confirm with counsel), with a disease-specific care plan.
30+ minutes of care-management time per month (not 20).
Billable by OB-GYN, NP, PA, and Certified Nurse Midwife → PCM 99424 (~$88). Cannot be billed the same month as CCM.

MARKABLE supplies

The organized patient data and between-visit trend the clinician builds and monitors the care plan from
The patient's self-reported symptom, THINK and SENSE data, and Hormonal Profile
The audit-grade documentation and time record the clinician reviews and signs
Presents the patient's own reported symptoms so the clinician can recognize and diagnose qualifying comorbidities

The clinician must do

Diagnose and document the qualifying conditions (MARKABLE never diagnoses)
Perform and contemporaneously log the qualifying care-management time
Own the care plan in the certified EHR and take patient consent
Provide continuity and 24/7 access; select and submit the code

Three lines you must not cross

Menopause itself never qualifies a patient. Eligibility runs through documented comorbidities, never the life stage. Padding the count is a False Claims Act risk.
Cleanest coverage is the 65+ Medicare panel. The perimenopausal commercial cohort depends on the payer; do not represent it as covered.
The code pays for the clinician's time, not for using MARKABLE. Never say "MARKABLE lets you bill $X." MARKABLE is the layer behind the clinician's own billable work.

Investor and B2B-clinic reference only, not for the public wellness site. MARKABLE is a general-wellness product, not an FDA device, not a clinical-decision-support tool, and not itself a reimbursable service; it does not diagnose, recommend treatment, or make clinical decisions. Amounts are 2026 Medicare national averages and must be confirmed against the CMS Physician Fee Schedule Look-up Tool for the specific locality, and all billing decisions confirmed with the clinic's own compliance counsel. Sources: CMS MLN909188 (CCM), CMS G2211 FAQ, RHIhub / AAPC (PCM), AAFP.