What does Chronic Care Management pay in 2026?
| Code | What it covers | CY2026 national non-facility |
|---|---|---|
| 99490 | first 20 min, clinical staff | $66.13 |
| 99439 | each added 20 min, max 2 units | $50.44 |
| 99491 | first 30 min, practitioner personally | $89.18 |
| 99437 | each added 30 min, practitioner personally | $63.13 |
| 99487 | complex CCM, first 60 min | $144.29 |
| 99489 | complex CCM, each added 30 min | $78.16 |
National averages from our verified CY2026 fee-schedule config (source: CMS Physician Fee Schedule). Actual payment varies by locality, payer, and site of service.
Who can bill it?
Physicians and the non-physician practitioners Medicare recognizes for evaluation-and-management services — nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives.
Clinical staff — nurses, care coordinators, and in many teams the therapists doing the day-to-day coordination — furnish the minutes under the billing practitioner's direction, and that time counts toward the threshold.
Only one practitioner can bill CCM for a given patient in a given month, and the patient's consent must say so. If you share a patient with another practice, whoever the patient designates is the biller that month.
What are the minute thresholds?
- 20 minutes of clinical-staff time in the calendar month opens the base code 99490.
- Each additional 20 minutes adds one unit of 99439, capped at 2 units — a 60-minute ceiling on the non-complex path (CMS MUE).
- Sixty minutes or more with moderate-to-high-complexity medical decision making belongs on complex CCM (99487, +99489 per added 30 minutes) instead.
- Time the billing practitioner spends personally bills 99491/99437 in 30-minute blocks.
- Minutes only count once: time already claimed by another billed service is excluded from the CCM threshold.
What has to be in place first?
- Patient consent, with the single-biller disclosure
- Consent must be documented before billing begins and must record that the patient was told only one practitioner can furnish and bill CCM in a given month. Consent missing that disclosure is not valid consent.
- Two or more chronic conditions
- Conditions expected to last at least 12 months (or until death) that put the patient at significant risk — a clinical judgment the practitioner attests to, not an ICD checklist.
- Enrollment and a shared care plan
- The patient is enrolled in the program with a comprehensive care plan the whole team can see, and 24/7 access to a care-team member for urgent needs.
- An initiating visit for new patients
- Patients new to the practice (or not seen within a year) need a qualifying visit — by the practitioner who will bill — before CCM starts.
- A complete claim identity
- The rendering practitioner's NPI and practitioner type have to be on file — a superbill without them is not a lawful claim.
What gets claims denied?
- Someone else already billed the month
- CCM is one-practitioner-per-patient-per-month. If another practice billed CCM for the same patient-month, the later claim denies — and a paid one can be recouped.
- APCM exclusivity
- A confirmed Advanced Primary Care Management bundle for the patient-month blocks CCM (and PCM and TCM) outright — the two models can't be billed together.
- Add-on units past the cap
- More than two 99439 units in a month exceeds the CMS MUE and denies. Past 60 minutes with complex decision-making, the correct move is complex CCM, not more add-ons.
- QMB balance-billing
- Qualified Medicare Beneficiaries cannot be billed Medicare cost-sharing. Collecting the CCM coinsurance from a QMB patient is a compliance violation, not a payer quirk.
- Assuming commercial parity
- Commercial payers adopt care-management codes unevenly; a payer that hasn't loaded them returns denials such as CO-181 (code invalid for this payer). Verify adoption before projecting commercial revenue.
- Double-counted minutes
- Time already claimed by another billed service — a therapy session, an E/M visit — cannot also fund the CCM threshold. Defensible capture means every minute is claimed once.
What could this look like for your panel?
Estimates only, not billing advice. Actual Medicare reimbursement varies by region, payer, and year. Figures approximate CY2026 national non-facility averages from our verified fee-schedule config.
Frequently asked questions
- What is CPT 99490?
- CPT 99490 is the CCM base code: the first 20 minutes of clinical-staff coordination time in a calendar month, directed by the billing practitioner, for a Medicare patient with two or more qualifying chronic conditions. The CY2026 national non-facility rate is about $66.13.
- Who can bill CCM?
- Physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives. Clinical staff furnish most of the minutes under the billing practitioner's direction — but only one practitioner bills per patient per month.
- Which patients qualify for CCM?
- Medicare patients with two or more chronic conditions expected to last at least 12 months (or until death) that place them at significant risk, who have consented, enrolled, and have a shared care plan with 24/7 care-team access.
- Can two practices bill CCM for the same patient in the same month?
- No. CCM is strictly one practitioner per patient per month, and the consent process must disclose that to the patient. The second claim for the same month denies.
- Can CCM and APCM be billed together?
- Not for the same patient-month. A confirmed APCM bundle is mutually exclusive with CCM, PCM, and TCM — a practice picks one model per patient per month.
- Is CCM a telehealth service?
- No. Care-management codes are not telehealth services, so no telehealth expiration cliff applies to them — the coordination happens between visits by design (telehealth flexibilities are a separate policy track, extended through 2027).
This page is general information, not billing, coding, or legal advice. Verify current requirements with the relevant payer before billing. Mallowa helps practices capture and document coordination time and generates claim-ready superbills; it does not submit claims or determine eligibility.