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Chronic Care Management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. The Centers for Medicare & Medicaid Services (CMS) recognizes that CCM is a critical component of primary care that promotes better health and reduces overall health care costs.
Key Takeaways
- CCM is billable for Medicare patients with two or more chronic conditions expected to last at least 12 months that put them at significant risk of death, acute exacerbation, or functional decline.
- Only one practitioner can bill CCM per patient per calendar month, and they must choose either complex or non-complex CCM, not both.
- Physicians, NPs, PAs, CNSs, and certified nurse-midwives can bill CCM; clinical staff time counts under general supervision on an “incident to” basis.
- Core codes: 99490/99439 (clinical staff time), 99491/99437 (practitioner time), and 99487/99489 (complex CCM).
- An initiating visit is required for new patients or those not seen within the past year, and documented patient consent is required before services start.
- Accurate time tracking, a comprehensive care plan, and 24/7 care access are essential to avoid denials and audit risk.
Practitioner Eligibility
Physicians and these non-physician practitioners may bill CCM services – Certified Nurse-Midwives; Clinical Nurse Specialists; Nurse Practitioners; and Physician Assistants. Only one practitioner may be paid for CCM services for a given calendar month. This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both).
CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. The CCM service is not within the scope of practice of limited-license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care.
CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the billing practitioner), subject to applicable state law, licensure, and scope of practice. The clinical staff is either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM.
CPT code 99491 includes the only time that is spent personally by the billing practitioner. Clinical staff time is not counted towards the required time threshold for reporting this code. CPT codes 99487, 99489, and 99490 – Time spent directly by the billing practitioner or clinical staff counts toward the threshold clinical staff time required to be spent during a given month.
Initiating Visit
For new patients or patients not seen within 1 year prior to the commencement of CCM, Medicare requires the initiation of CCM services during a face-to-face visit with the billing practitioner (an Annual Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or other face-to-face visits with the billing practitioner). This initiating visit is not part of the CCM service and is separately billed.
Practitioners who furnish a CCM initiating visit and personally perform extensive assessment and CCM care planning outside of the usual effort described by the initiating visit code may also bill HCPCS code G0506 (Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services [billed separately from monthly care management services] [Add-on code, list separately in addition to primary service]). G0506 is reportable once per CCM billing practitioner, in conjunction with CCM initiation.
Approaches to Help Your Practice Get Started
- Identify Medicare Part B patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient.
- Prioritize patients at the highest risk of hospitalization or have recently been/are regularly seen in the emergency room.
- Start with patients that regularly call into the clinic to manage symptoms or with medical questions.
- Identify patients that may be most likely to benefit from care management based on the number of specialists involved in their care or who have limited social or local family support.
- Identify patients dually eligible for traditional Medicare and Medicaid (not managed Medicaid).
- Identify volume needed to hire additional part-time or full-time staff and then prioritize eligible patients.
CCM Coding
The four CPT codes used to report CCM services are 99490, 99491, 99487, and 99489
CPT 99490:
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
- Comprehensive care plan established, implemented, revised, or monitored
- Assumes 15 minutes of work by the billing practitioner per month.
CPT 99491:
Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of the physician or other qualified health care professional time, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
- Comprehensive care plan established, implemented, revised, or monitored
CPT 99487:
Complex chronic care management services, with the following, required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
- Establishment or substantial revision of a comprehensive care plan
- Moderate or high complexity medical decision making
- 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
CPT 99489:
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure). Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately.
Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes additional to the first 60 minutes of complex CCM services during a calendar month.
Hopefully, these guidelines help you understand the basics of billing Chronic Care Management. As always, make sure to check with your local Medicare carrier and other insurance companies on their rules and policies on how to bill for CCM.
In case of any issues billing for chronic care management, contact Medical Billers and Coders (MBC) at 888-357-3226/ info@medicalbillersandcoders.com
CCM Reimbursement Rates and Pricing (2026)
Medicare pays CCM per patient, per calendar month. The amounts below are approximate CY2026 national averages under the Medicare Physician Fee Schedule; actual payment varies by locality (GPCI), place of service, and payer.
| CPT Code | Service | Time Requirement | Approx. 2026 Medicare Payment |
|---|---|---|---|
| 99490 | Non-complex CCM (clinical staff) | First 20 minutes/month | ~$66 |
| 99439 | Add-on to 99490 | Each additional 20 minutes (max 2/month) | ~$50 |
| 99491 | CCM provided personally by physician/QHP | First 30 minutes/month | ~$89 |
| 99437 | Add-on to 99491 | Each additional 30 minutes | ~$63 |
| 99487 | Complex CCM | First 60 minutes/month | ~$144 |
| 99489 | Add-on to 99487 | Each additional 30 minutes | ~$78 |
Revenue example: A practice enrolling 100 eligible patients in non-complex CCM (99490 only) can generate roughly $6,600 per month, or about $79,000 per year, before add-on codes. Patients typically owe 20% coinsurance after the Part B deductible, which secondary insurance often covers.
Cost of outsourcing CCM billing: Medical billing companies generally charge a percentage of collections or a flat monthly fee per enrolled patient, depending on whether the service covers only claims submission or also includes care coordination support, time tracking, and denial management. For a custom quote based on your patient volume and specialty, contact Medical Billers and Coders.
FAQs
CCM services are non-face-to-face support for Medicare beneficiaries with multiple chronic conditions, aimed at improving health and reducing costs.
Eligible practitioners include physicians, nurse-midwives, nurse practitioners, and physician assistants, but only one practitioner can bill for a patient per month.
The primary CPT codes are 99490, 99491, 99487, and 99489, each corresponding to different time requirements and levels of complexity in care management.
Yes, for new patients or those not seen in over a year, an initiating face-to-face visit is required before starting CCM services.
Start by identifying eligible Medicare patients with chronic conditions, prioritizing those at high risk of hospitalization, and consider staffing needs based on patient volume.
CPT 99490 covers at least 20 minutes of clinical staff time per month under the direction of a billing practitioner, while CPT 99491 requires at least 30 minutes of time spent personally by the physician or qualified health care professional. The two cannot be billed for the same patient in the same month.
Approximate 2026 national averages are about $66 for 99490, $50 for 99439, $89 for 99491, $63 for 99437, $144 for 99487, and $78 for 99489. Actual payment varies by geographic location and place of service.
Yes. Practitioners must obtain and document verbal or written consent before starting CCM, after informing the patient about the service, applicable cost-sharing, and their right to stop CCM at any time.
Yes. CMS allows CCM to be billed in the same month as Remote Patient Monitoring (RPM) and Transitional Care Management (TCM), as long as the same time is not counted toward more than one service and all code requirements are met.
CCM is a Medicare Part B service, so patients generally owe 20% coinsurance after meeting the Part B deductible. Supplemental or Medicaid coverage often pays this amount.
Documentation should include patient consent, a comprehensive electronic care plan shared with the patient, the chronic conditions being managed, total time spent each month and who spent it, and evidence of 24/7 access to care and continuity of care.
Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.
