Anthem Blue Cross and Blue Shield Chronic Care Management (CCM) Reimbursement Rates for Colorado Primary Care Practices (2026)

Chronic care management (CCM) is its own billing category, distinct from remote patient monitoring and remote therapeutic monitoring: it is built around ongoing care-management time for patients with multiple chronic conditions, not device-based monitoring. For the primary care, internal medicine and geriatrics practices that bill this code family, CCM is recurring monthly revenue, which makes the negotiated rate behind each CPT code compound across every enrolled patient. Anthem’s statewide Colorado rate is a starting point for that math, not a contract rate. See how CPT-level verification works.

On methodology: every figure on this page comes from Fuse’s own extraction of the statewide network file Anthem published for Colorado in August 2026. From that file we kept the dollar-denominated fee schedule rates attached to these CPT codes (percentage-of-charges rows are excluded), then used the federal NPPES registry to narrow the provider universe to individual internal medicine and family medicine physicians, nurse practitioners and physician assistants practicing in Colorado, the clinician types that run most CCM programs. Statistics are computed across distinct provider-rate pairs. This page covers CCM only; the companion analyses cover Anthem’s RPM rates in Colorado and Anthem’s RTM rates in Colorado.

Anthem’s Rates for Chronic Care Management (CCM) CPT Codes in Colorado

Anthem Blue Cross and Blue Shield publishes negotiated rates for chronic care management through its Colorado Machine Readable Files. The table below reflects August 2026 data for five CCM codes, all of which carried usable Colorado rate data in this extraction. Note that 99491 is its own base code for the physician’s or qualified health professional’s personal time, distinct from 99490’s clinical-staff-time model; it is not an add-on to 99490.

Rates extracted from Anthem’s August 2026 Colorado machine readable files.

Anthem’s files update monthly, so this table is labeled with its extraction date and should not be treated as a fixed, permanent figure.

What Anthem’s Colorado CCM Rates Actually Tell You

Treat the table as a market map, not a price list. Anthem’s Colorado file is organized by employer EIN for group plans and by HIOS number for individual plans, which means a statewide mean averages across thousands of separately negotiated arrangements. The contract behind one practice’s 99490 rate can sit far from the contract behind its neighbor’s, even for the same code in the same county, and the spread between the min and max columns above is the honest picture of that variation.

The file is also a snapshot. Anthem publishes these machine readable files on a monthly cycle as comprehensive negotiated in-network rates with historical out-of-network data (Anthem, Machine Readable Files), and next month’s file supersedes this one. Between the file and the remittance sit coverage rules, plan edits and billing mechanics, so a listed rate is evidence of what the network pays, not a promise about a specific claim.

Anthem’s Coverage Requirements for CCM in Colorado

Here the research finding is an asymmetry worth stating directly. We identified Anthem’s published clinical policy CG-MED-91 for remote patient monitoring and remote therapeutic monitoring services, which addresses monitoring-service medical-necessity criteria. We did not identify a separate Anthem Colorado CCM clinical policy or prior-authorization requirement in the materials reviewed. That absence is not a green light: practices should confirm the applicable member plan’s current coverage and authorization rules before billing CCM.

Physician-Led Chronic Care Management Billing With CPT 99491

For physician- and QHP-led programs that do not route CCM time through clinical staff, CPT 99491 is the relevant base code. Per CMS’s chronic care management guidance, 99491 covers chronic care management services provided personally by a physician or other qualified health care professional, 30 minutes or more per calendar month. It covers the practitioner’s own time, where 99490 covers clinical-staff time directed by the practitioner; the two are parallel bases, not tiers of each other. This is the code descriptor; Anthem-specific coverage and authorization for 99491 should be confirmed with the member plan like any other CCM claim.

Why CCM Can’t Be Billed on the Same Clock as RPM or RTM

This is the core denial-risk mechanism for CCM specifically: a patient can qualify for CCM alongside remote patient monitoring or remote therapeutic monitoring, but the same clinical-staff or practitioner time cannot be counted toward more than one service in the same period. Documentation has to support separately qualifying work for each service billed. Practices running combined programs should read this page alongside Anthem’s Colorado RPM reimbursement rates and Anthem’s Colorado RTM reimbursement rates.

What This Means for Your Practice

For CCM the operational question is always plan-specific: what does this member’s plan cover, and what documentation does it expect, given that Anthem publishes no standalone CCM clinical policy to consult. A statewide average answers neither question, and the non-double-counting rule raises the cost of guessing wrong. Fuse closes that gap by checking reimbursements against a practice’s own past claims and placing automated phone calls to payers to confirm coverage, so the difference between expected and actual payment surfaces early instead of accumulating as quiet write-offs.

Verify CCM Coverage and Billing Before Every Claim

With no published Anthem CCM policy to lean on, plan-level verification is the only reliable answer to what a specific patient’s coverage requires, and the non-double-counting rule makes clean documentation the difference between a paid claim and a denial. Fuse verifies current eligibility and plan-specific benefits at the CPT code level before the visit, combining past claims data with automated phone calls to payers, helping practices estimate expected copay, coinsurance and deductible responsibility and get paid what they are contractually owed. See how CPT-level verification works.

Disclaimer: This article uses rate information from the Machine Readable Files that Anthem Blue Cross and Blue Shield publishes under the federal Transparency in Coverage rule. These files are posted to satisfy the regulation, not to be read: the file behind this analysis unpacks to 3 gigabytes of raw pricing data, millions of negotiated rates that no spreadsheet can open. Fuse built its own pipeline to extract and verify the figures above. This analysis focuses on a single payer and will not reflect rates from all available insurance options in Colorado. Fuse makes every effort to provide accurate and current information, but healthcare pricing can change frequently, and individual circumstances may affect actual costs. This information does not guarantee specific pricing. Practices should verify current rates directly with Anthem before relying on them for billing or negotiation decisions.