Why Patients Drop Out of CCM, and What Practices Can Do

Updated October 2026. Written by Matteo Grassi, cofounder of HANA Health, trained in psychology.

Patients stop Chronic Care Management (CCM) mostly because they don't see its value, hit an unexpected copay, or never really enrolled in the first place. In Medicare claims for 2015 to 2019, nearly one in five CCM recipients didn't continue after the first service (Jang et al., 2024). In the program's first year, enrolled patients averaged about four months of billed CCM.

As a psychologist, I'd say a patient who can't name what the monthly call does for them will drop it the first time it feels like a chore.

Key facts

• Nearly 1 in 5 Medicare CCM recipients did not continue after the initial service, in 2015 to 2019 claims (Jang et al., Journal of the American Geriatrics Society, 2024).
• CCM use among eligible older adults with two or more chronic conditions rose from 1.1% in 2015 to 3.4% in 2019 (Jang et al., 2024).
• In 2019, only 4.0% of potentially eligible fee for service beneficiaries received any CCM, and 5.2% of practices with eligible patients billed it (ASPE and NORC, 2022).
• In 2015, CCM beneficiaries received an average of four months of CCM over the first 12 months of the program, with a median of five (O'Malley et al., Journal of General Internal Medicine, 2017).
• Patients can stop CCM at any time, effective at the end of the calendar month (CMS MLN909188, June 2025).
• Medicare's 2026 national payment for 99490 is $66.13 a month (CMS Physician Fee Schedule file RVU26D), so the patient's 20% coinsurance is about $13.23 when no supplemental plan covers it.

Why do patients stop CCM after the first month?

Most patients stop because the benefit stays invisible, the cost surprises them, or the program never earned a place in their routine. The claims data tell us how many leave, but not why. The reasons come from small interview studies, so treat them as patterns to check in your own practice, not as national rates.

In the CMS commissioned evaluation, researchers interviewed 48 beneficiaries. Three had already discontinued CCM. One had switched doctors for unrelated reasons, and two stopped after they learned about the copay, which they said they didn't know about when they consented (Mathematica for CMS, 2017). Three more planned to stop because they didn't think they needed the service.

That second group matters most. A patient who feels healthy and gets a monthly call about a care plan they've never seen has no reason to stay. Silence from the practice between calls makes it worse.

How many patients actually leave?

The best national number is the Jang finding: nearly one in five recipients didn't continue after the initial service. That comes from a 5% random sample of fee for service Medicare claims for adults 65 and older, 2015 to 2019. It describes the early program, and claims can't tell a patient who chose to leave from a practice that stopped delivering the service.

The older figure is blunter. During 2015, patients enrolled in CCM received an average of four months of services in the first year, with a median of five and a range from one to twelve months (O'Malley et al., 2017). Since CCM can be billed every month, a four month average means most patients weren't billed for most of the year.

Neither number is a current benchmark. Your own claims are. Count how many patients billed in month one also billed in month four.

What does an early drop out cost a practice?

An early drop out costs a practice most of a patient's potential annual 99490 revenue. Here's the arithmetic, using the 2026 national payment and ignoring locality adjustments, sequestration and any add on codes.

• Full year, one patient: 12 months x $66.13 = $793.56.
• Four month patient: 4 months x $66.13 = $264.52.
• Gap per patient: $793.56 minus $264.52 = $529.04.
• Across 100 enrolled patients: 100 x $529.04 = $52,904 a year if the average stay is four months instead of twelve.

This assumes the practice delivers and documents 20 minutes of clinical staff time every month, which is the part that costs money. A patient who leaves also takes the care plan work you've already done. For the code level detail, see our guide to CCM billing codes.

Does the copay push patients out?

Sometimes. CCM is a Part B service, so the usual cost sharing applies. Medigap plans and other supplemental coverage often pick it up, and CMS notes that most dually eligible patients aren't responsible for cost sharing (CMS CCM toolkit).

The Mathematica interviews showed the gap. Several patients with supplemental coverage didn't know about any fee. About one in five said they'd take part whether or not insurance covered it, and a larger share said they wouldn't if they had to pay out of pocket. At the 2026 rate, that out of pocket amount is about $13.23 a month, or $158.76 over 12 months (12 x $13.23).

The fix is simple and it's already a Medicare requirement. Tell patients about possible cost sharing at consent and document it. Our consent and care plan guide covers the full list.

How can practices keep patients enrolled?

Practices keep patients by making each month's contact visibly useful and by catching early warning signs. None of these steps has been proven in a randomized trial for CCM retention, so treat them as sound practice, not guaranteed results.

1. Explain the point in plain words at consent. Say what the patient gets: a named care team contact, a written plan, and help between visits.
2. Confirm coverage before the first bill. Check for Medigap or Medicaid, and say what a patient with no supplement might owe.
3. Make the first contact early. Reach patients within the first week, not at the end of the month, so the first claim isn't also the first conversation.
4. Share the care plan. Give the patient a copy, so they have something concrete to point to when they wonder what the program does.
5. Track month two and month four. Flag anyone who missed a contact and call before the next billing month closes.
6. Let patients leave cleanly. CMS says patients can stop at any time, effective at the end of the month. A clear exit keeps trust for a later restart.

What this means for your practice

Treat retention as a metric you report monthly, next to enrollment. A practice that adds 20 patients a month and loses 15 is running hard to stay in place.

Start with a simple cohort table from your own claims: patients first billed in a given month, and how many billed again 3 and 6 months later. Then call a sample of patients who left and ask why. Ten honest calls will teach you more than any national average.

HANA builds phone based outreach for practices running care management programs, so enrollment and monthly check in calls reach patients who don't open apps. Billable clinical time still has to come from your clinical staff. You can read more on our care coordination page. For the pillar overview, start with what CCM is.

Frequently asked questions

Can a patient restart CCM after stopping?

Yes. Consent is needed only once unless the patient switches to a different CCM practitioner, so a returning patient with documented consent doesn't need a new one (CMS MLN909188, June 2025). Confirm your chart still shows consent and a current care plan.

Does a patient have to give a reason for stopping?

No. CMS says patients may stop CCM at any time, effective at the end of the calendar month. Asking is still smart, because the answer shows you what to fix.

Is it a problem if a patient is billed some months and not others?

It's common, not automatically a problem. CCM is billed only in months when the full service and the required time were delivered and documented. A skipped month with no documentation is better than an unsupported claim.

Which patients are most likely to stay?

The claims data show higher use among patients with more chronic conditions and greater frailty, for example 7.0% of those with ten or more conditions versus 2.1% of those with two to five in 2019 (Jang et al., 2024). That's use, not retention, so it doesn't prove those patients stay longer.

Who is allowed to bill CCM if a patient changes doctors?

Only one practitioner can bill CCM in a calendar month. If the patient moves to a new practice, the new practitioner needs fresh consent and the old practice stops billing.

Sources

1. Jang J, McCarthy EP, Olivieri-Mui B, et al. Use of chronic care management service among Medicare beneficiaries in 2015 to 2019. Journal of the American Geriatrics Society, 2024. https://doi.org/10.1111/jgs.19066
2. ASPE and NORC. Analysis of 2019 Medicare FFS Claims for CCM and TCM Services, 2022. aspe.hhs.gov
3. O'Malley AS, Sarwar R, Keith RE, et al. Provider Experiences with Chronic Care Management Services and Fees. Journal of General Internal Medicine, 2017. pmc.ncbi.nlm.nih.gov
4. Schurrer J, O'Malley A, Wilson C, et al. Evaluation of the Diffusion and Impact of the Chronic Care Management Services: Final Report. Mathematica for CMS, 2017. cms.gov
5. CMS Medicare Learning Network. MLN909188 Chronic Care Management Services, June 2025. cms.gov
6. CMS. Chronic Care Management Toolkit. cms.gov
7. CMS. Physician Fee Schedule relative value files, 2026 release. cms.gov
8. CMS. Calendar Year 2026 Medicare Physician Fee Schedule Final Rule fact sheet, October 2025. cms.gov

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you want to look at retention in your own program, book a discovery call.