CPT 99490 in summary
CPT 99490 is billed once per calendar month per patient when the practice provides at least 20 minutes of clinical staff time directing CCM activities under the supervision of a physician for a Medicare patient with two or more chronic conditions expected to last at least 12 months. Requirements include patient consent, a comprehensive care plan, 24/7 access to care management staff, and electronic capture of activities. CMS pays approximately $62 per use (national average, 2026 rates). Add-on code 99439 covers each additional 20 minutes (up to 60 total).
- 20 minutes minimum clinical staff time per month
- Two or more chronic conditions, 12-month expected duration
- Patient consent + comprehensive care plan required
- 24/7 access requirement
Chronic Care Management Billing: CPT 99490 and the Family
By MedPrecision Operations Team · Published
Chronic Care Management (CCM) is a Medicare-recognized non-face-to-face service category that pays physicians for the clinical and care coordination work between visits for patients with multiple chronic conditions. CMS introduced CPT 99490 in 2015 as the first CCM code, and the family has expanded since to include 99439, 99487, and 99489. CCM revenue is meaningful for primary care practices — and the documentation requirements are specific enough that practices billing CCM without disciplined workflows accumulate compliance risk.
What Chronic Care Management Is
Chronic Care Management is a Medicare-recognized service category covering non-face-to-face clinical and care coordination work for patients with multiple chronic conditions. CMS introduced CPT 99490 effective January 1, 2015, defining the base CCM service: at least 20 minutes of clinical staff time per calendar month, directed under physician supervision, for a Medicare patient with two or more chronic conditions expected to last at least 12 months or until the patient's death and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. The service is delivered remotely between face-to-face encounters and includes activities such as medication management, care coordination across providers, ongoing assessment and care plan revision, and patient and caregiver communication.
The Six Specific Requirements
Six conditions must be met for any CCM billing month. First, the patient must have two or more chronic conditions meeting the duration and severity criteria. Second, the patient must provide informed consent — verbal or written — before CCM services begin, and the consent must be documented in the medical record. Third, a comprehensive care plan must be established, documented, and shared with the patient, and the patient must have a copy. Fourth, the practice must provide 24/7 access to care management staff for urgent care needs related to the patient's chronic conditions. Fifth, the clinical staff must spend at least 20 minutes during the calendar month on CCM activities. Sixth, the activities must be captured electronically — typically in a structured CCM module within the EHR or in a dedicated CCM platform that timestamps activities.
The CCM Code Family
Beyond CPT 99490 (base 20 minutes), the CCM family includes several related codes. CPT 99439 — each additional 20 minutes of clinical staff CCM time per calendar month, billable up to twice (60 minutes total). CPT 99491 — at least 30 minutes of CCM time provided personally by the physician (rather than clinical staff), reflecting more direct physician involvement. CPT 99437 — each additional 30 minutes of physician personal CCM time. CPT 99487 — Complex CCM with at least 60 minutes of clinical staff time and moderate or high complexity medical decision making. CPT 99489 — additional 30 minutes of complex CCM. CMS values for 2026 average approximately $62 for 99490, $48 for 99439, $84 for 99491, and $135 for 99487. Total CCM revenue per patient per year can exceed $1,500 with combined codes; the typical primary care patient in active CCM averages 99490 plus 99439 each month.
Patient Consent Requirements
Before CCM services begin, the patient must consent. CMS allows verbal consent (which must be documented in the chart) or written consent. The consent process must inform the patient of the availability of CCM services, the cost-sharing responsibility (CCM is subject to the standard 20% Medicare coinsurance unless the patient has supplemental coverage), and the right to revoke consent at any time. The patient must understand that only one provider can bill CCM for the patient in a given month. CMS guidance in the CCM FAQ specifies that consent must be obtained at a face-to-face visit (an Annual Wellness Visit, Initiating Visit, or established E/M). The face-to-face initiation requirement was relaxed during the public health emergency and has subsequently been formalized as allowing audio-video telehealth visits to count as the initiating visit for CCM in some scenarios.
The Comprehensive Care Plan
The comprehensive care plan is the documented treatment plan covering the patient's chronic conditions, social determinants of health, advance care preferences, and care coordination needs. The plan must include: a problem list, expected outcome and prognosis, measurable treatment goals, symptom management, planned interventions, medication management, community/social services ordered, responsible providers and their roles, requirements for follow-up and periodic review, and how services will be coordinated. The plan must be electronic, available to the care team and the patient, and revised as needed based on the patient's status. CMS does not prescribe a single template — practices use various structured care plan modules in their EHR or dedicated CCM software. The plan should be reviewed and updated at least annually and whenever a significant clinical change occurs.
Time Tracking and Activity Capture
The 20 minutes of clinical staff time must be captured electronically and tied to specific CCM activities. Activities counting toward CCM time include phone calls with the patient or caregivers, medication reconciliation, communication with other treating providers, ordering and reviewing test results, completing prior authorizations related to chronic condition management, and arranging community services. Activities that do not count include face-to-face visits (those are billed separately as E/M), travel time, and clinical activities for conditions outside the established care plan. Time from multiple staff members can aggregate as long as each contribution is documented separately. Most CCM platforms generate a monthly time report; the report serves as the audit trail in the event of a Medicare contractor review.
Audit Risks and Compliance Considerations
CCM has appeared on the OIG Work Plan, particularly for documentation gaps. Common audit findings include: CCM billed without documented patient consent in the chart; CCM billed without a comprehensive care plan or with a minimal/template plan that lacks the required elements; CCM time recorded without specific activities tied to the time; CCM billed for the same patient by multiple providers in the same month; CCM billed for patients without two qualifying chronic conditions or without conditions meeting the duration/severity criteria. Practices billing CCM at high volume should perform internal audits quarterly on a sample of charts to verify the consent, care plan, and time documentation are present and substantive. Consistent internal auditing is the most effective protection against the False Claims Act exposure that CCM's documentation requirements create.
Common Questions
Common questions about chronic care management billing (cpt 99490): the complete rules.
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Get a Free Billing Audit arrow_forwardWhat are the requirements for billing CPT 99490?
Six conditions must be met for billing CPT 99490 in any calendar month. The patient must have two or more chronic conditions expected to last at least 12 months and place the patient at significant risk of death, acute exacerbation, or functional decline. The patient must have provided informed consent — verbal or written, documented in the medical record. A comprehensive care plan must be established, documented, and shared with the patient. The practice must provide 24/7 access to care management staff for urgent chronic care needs. Clinical staff must spend at least 20 minutes during the calendar month on CCM activities under physician supervision. The activities and time must be captured electronically with specific activities tied to the time. Missing any of the six requirements disqualifies the month for CCM billing.
How much does Medicare pay for chronic care management?
CPT 99490 reimburses at approximately $62 per use under the 2026 national Medicare physician fee schedule. The CCM family includes additional codes that allow expanded billing per patient per month. CPT 99439 (each additional 20 minutes of clinical staff CCM time) reimburses approximately $48, billable up to twice for 60 minutes total clinical staff time. CPT 99491 (30 minutes of physician personal CCM time) reimburses approximately $84. CPT 99437 (each additional 30 minutes of physician CCM time) reimburses approximately $63. CPT 99487 (complex CCM, at least 60 minutes of clinical staff time with moderate/high complexity) reimburses approximately $135. CPT 99489 (additional 30 minutes of complex CCM) reimburses approximately $66. Total CCM revenue per patient per year can range from $740 (99490 alone monthly) to $1,500+ when combined codes apply.
Does the patient have to pay for CCM?
Yes — Chronic Care Management is subject to the standard Medicare 20% coinsurance unless the patient has supplemental coverage. For a 2026 99490 service reimbursed at approximately $62, the patient owes approximately $12.40 unless covered by Medigap, Medicare Advantage cost-sharing, Medicaid (for dual-eligibles), or a supplement plan. The patient cost-sharing requirement must be disclosed during the consent process — patients must be told about the financial responsibility before CCM services begin. Some patients decline CCM enrollment after learning about the coinsurance, which is one reason CCM enrollment rates are lower than initial CMS modeling projected. Practices that proactively explain the value (24/7 access, care coordination, medication management) and the typical out-of-pocket cost (often under $15/month) generally see higher enrollment than practices that mention only the cost.
Can I bill CCM and an E/M visit in the same month?
Yes. Chronic Care Management and standard office E/M visits are separately billable in the same month — the CCM service covers non-face-to-face clinical and care coordination work, distinct from the face-to-face E/M visit work. The CCM time and activities recorded must not include time spent during the face-to-face visit itself; that is captured separately as part of the E/M code. Documentation should clearly separate the CCM activities (with timestamps and specific activities) from the E/M visit note. Practices that bill CCM and E/M in the same month should ensure their documentation establishes the separation; commingled documentation that doesn't clearly distinguish CCM time from E/M time is a common audit finding. Some practices bill CCM monthly even in months with face-to-face visits; others bill CCM only in months without face-to-face visits as a conservative posture.
Can multiple providers bill CCM for the same patient?
No. Only one provider can bill CCM for a given patient in a given calendar month. The patient must designate a single provider as the CCM provider during the consent process, and that provider is the only one authorized to bill CCM codes for that patient that month. If the patient changes CCM provider mid-cycle, the change should be documented and the new provider's CCM billing begins the following month. Common audit findings include CCM billed by multiple providers for the same patient in the same month — this triggers automated CMS data analytics and Medicare contractor review. Practices that participate in shared-care arrangements (primary care plus a specialist managing a single chronic condition) should clarify who holds the CCM responsibility and ensure only that provider bills CCM.
What chronic conditions qualify for CCM?
CMS does not publish a closed list of qualifying conditions. The qualifying criteria are functional rather than diagnostic: the condition must be expected to last at least 12 months or until the patient's death, and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. The patient must have at least two such conditions. Common qualifying conditions include diabetes, hypertension, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, dementia, chronic depression with comorbid medical conditions, atrial fibrillation, chronic ischemic heart disease, osteoporosis, and others. The chart must reflect the conditions, the duration/severity meeting CCM criteria, and the link between the conditions and the CCM activities. Documentation establishing only that the patient has the diagnoses without addressing the duration and severity criteria is a common audit gap.
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