CCM Billing Requirements 2026: CPT 99490, 99439, 99487, 99489 and 99491 Explained

By Jay Chowdappa, MD, co-founder and CEO, Zynix AI · Updated October 30, 2026

Key takeaways

Medicare pays for chronic care management (CCM) when a patient has two or more chronic conditions expected to last at least 12 months that put them at significant risk, has given consent, and has had an initiating visit. CPT 99490 covers the first 20 minutes of clinical staff time in a calendar month, 99439 each additional 20 minutes, and 99487 the first 60 minutes of complex CCM.

• Get written or verbal consent once and document it: that CCM is available, that cost sharing applies, that only one practitioner can bill it in a month, and that the patient can stop at any time.
• New patients, and patients you have not seen in the past year, need an initiating visit first: a comprehensive E/M visit, an Annual Wellness Visit or an Initial Preventive Physical Exam where CCM is discussed.
• Pick one code family per patient per month: clinical staff CCM (99490, 99439), practitioner CCM (99491, 99437) or complex CCM (99487, 99489).
• CCM can be billed during the 30-day TCM period, but not by a practitioner who bills APCM for the same patient in the same month.

What is chronic care management (CCM)?

CCM is a monthly Medicare Physician Fee Schedule service for managing a patient's multiple chronic conditions between visits. It is mostly non-face-to-face work: keeping an electronic care plan current, checking in with the patient, reconciling medications, coordinating with other providers and community services, and managing care transitions.

CMS describes CCM as a critical primary care service, built around a continuous relationship with a chosen care team member, 24/7 access to care, preventive care, and prompt sharing of health information inside and outside the practice. Primary care practitioners bill it most often, but specialists may also provide and bill it.

Which patients qualify for CCM?

A patient qualifies for CCM when they have two or more chronic conditions that are expected to last at least 12 months, or until death, and that place them at significant risk of death, acute exacerbation or decompensation, or functional decline. CMS lists examples such as:

• Alzheimer's disease and related dementia, depression and substance use disorders
• Diabetes, hypertension, cardiovascular disease and atrial fibrillation
• COPD, asthma, arthritis, cancer, glaucoma, HIV and AIDS, and autism spectrum disorders

CMS suggests practices can find candidates with the criteria in CPT guidance, such as the number of illnesses, the number of medications, or repeat admissions and emergency department visits. Part B cost sharing applies to CCM, so tell patients before they enroll; some have Medigap coverage that helps with it.

CCM codes at a glance

The code depends on who does the work and how much time is spent in the calendar month. Add-on codes are marked with a plus sign.

Time rules matter. For 99490, 99439, 99487 and 99489, clinical staff time counts, and so does billing practitioner time that is not used to report 99491. For 99491 and 99437, only time the billing practitioner spends personally counts. Time counted toward a CCM code cannot be counted toward any other billed code.

What must be in place before you bill CCM?

Three things come before the first CCM claim: patient consent, an initiating visit when one is required, and structured recording of the patient's information in certified EHR technology.

1. Consent. Get the patient's written or verbal consent and document that you told them CCM is available, that cost sharing may apply, that only one practitioner can provide and bill CCM in a calendar month, and that they can stop at any time (effective at the end of the month). Record whether they accepted or declined. Consent is needed only once, unless the patient switches to a different CCM practitioner.
2. Initiating visit. New patients and patients the billing practitioner has not seen within the previous year need an initiating visit: a comprehensive face-to-face E/M visit, an Annual Wellness Visit or an Initial Preventive Physical Exam. CCM must be discussed during that visit. The initiating visit is billed separately.
3. Certified EHR. Record the patient's demographics, problems, medications and medication allergies in a certified EHR version that meets CMS's requirement for the payment year.

What service elements does CMS require for CCM?

Every CCM month should be backed by the service elements CMS lists for both non-complex and complex CCM. In practice that means a practice-level capability plus documentation for each patient:

• A comprehensive electronic care plan, created, revised and monitored, based on a physical, mental, cognitive, psychosocial, functional and environmental assessment. It typically covers the problem list, measurable goals, symptom and medication management, planned interventions, the caregiver's role and outside resources. Share it promptly inside and outside the practice, and give the patient or caregiver a copy when needed.
• 24/7 access to a physician, qualified practitioner or clinical staff for urgent needs.
• Continuity of care with a designated care team member the patient can schedule routine appointments with.
• Comprehensive care management: assessing medical, functional and psychosocial needs, making sure preventive services happen, reviewing medications and interactions, overseeing medication self-management, and coordinating with home- and community-based providers.
• Care transitions: referrals, follow-up after emergency department visits and discharges, and continuity-of-care documents shared with other practitioners.
• Enhanced communication: phone plus secure messaging, a portal or other asynchronous methods.

Who can bill CCM, and who can do the work?

Physicians (MD and DO), nurse practitioners, physician assistants, clinical nurse specialists and certified nurse-midwives may bill CCM. Clinical staff can furnish the services incident to the billing practitioner, subject to state law, licensure and scope of practice. Clinical staff may be employees or work under contract with the billing practitioner.

CMS assigns general supervision to the clinical staff codes (99490, 99439, 99487 and 99489). The billing practitioner directs and controls the service but does not have to be physically present. Limited-license practitioners such as clinical psychologists, podiatrists and dentists cannot bill CCM, though CCM practitioners may consult them or refer patients to them.

99490 vs 99487: how do you choose?

Use 99490 for standard CCM when clinical staff spend at least 20 minutes in the month. Use 99487 when the month also involves moderate or high complexity medical decision making by the billing practitioner and at least 60 minutes of clinical staff time.

You cannot report non-complex and complex CCM for the same patient in the same calendar month, and 99491 or 99437 cannot be reported in the same month as 99487, 99489, 99490 or 99439. If a patient's month turns complex, choose one family for that month.

Which services can be billed with CCM in the same month?

Most concurrent billing questions come down to a short list of rules from CMS's CCM booklet and the 2025 fee schedule rule:

• CCM codes 99487, 99489, 99490 and 99491 may be reported for services during the 30-day transitional care management (TCM) period (CPT 99495 and 99496).
• CCM cannot be billed in the same service period as home health supervision (G0181), hospice supervision (G0182) or certain ESRD services (CPT 90951 to 90970).
• Complex CCM cannot be reported in the same calendar month as prolonged E/M services.
• Either remote physiologic monitoring (RPM) or remote therapeutic monitoring (RTM), but not both, may be billed concurrently with CCM or TCM.
• RHCs and FQHCs can bill CCM and TCM for the same patient in the same period.
• Since 2025, the practitioner who bills advanced primary care management (APCM) for a patient cannot bill CCM for that patient in the same month. A different practitioner in the same practice may, when it is medically necessary.

CPT instructions list further codes that cannot be reported with CCM, and practices in a CMS model or demonstration may face extra restrictions. Check both.

When do you submit the CCM claim?

The CCM service period is one calendar month. For 99490, 99439, 99491 and 99437, you may bill at the end of the month, or as soon as the time threshold is met, using that date as the date of service. CMS still expects the care team to keep furnishing medically necessary services for the rest of the month. For complex CCM (99487 and 99489), report at the end of the service period, because medical decision making is judged across the whole month.

What changed recently, and what is still open?

The CCM code set itself is stable; the bigger changes are around it.

• 2025: CMS created APCM codes G0556, G0557 and G0558, a monthly primary care bundle that is not time-based. CMS updated its CCM booklet in June 2025 to describe APCM next to CCM, principal care management, principal illness navigation and community health integration.
• 2026: The CY 2026 fee schedule added optional behavioral health add-on codes for APCM, which matters if you are weighing a move from CCM to APCM.
• 2027 (proposed): The CY 2027 proposed rule, published July 16, 2026, asks for comment on how to reconfigure the care management code family, what the right initiating visit or trigger should be, how supervision should work in technology-enabled care, and how to reduce fraud, waste and abuse. These are requests for information, not final policy. Read the CY 2027 final rule before you change workflows.

How do practices run CCM month to month?

CCM revenue depends less on the codes than on the monthly routine: enrolling eligible patients with documented consent, reaching each enrolled patient, logging clinical staff time against the right code, and keeping the care plan current. A workable routine:

1. Build the eligible list from problem lists and claims, and confirm each patient has a qualifying initiating visit.
2. Capture and document consent, including the cost-sharing explanation, before the first billed month.
3. Schedule each enrolled patient's monthly contact and medication review, and route anything clinical to a nurse or the billing practitioner.
4. Log time by staff type as it happens, so each patient lands on the right code family at month end.
5. Review the month's claims against the time logs and care plan updates before submission.

Only time spent by clinical staff or the billing practitioner counts toward CCM thresholds, so plan on automated reminders and messages adding reach, not minutes. Zynix AI's Embedded Care Management Platform runs CCM care plans with tasks, owners and escalation by rule, and its voice and text agents handle reminders, scheduling and routine check-ins within the scripts your team sets. See how this works for chronic care management across an ACO panel, where symptom and adherence changes go to care managers and CCM time is reviewed by the billing provider.

This guide summarizes Medicare rules as CMS published them as of October 30, 2026. It is not legal or coding advice. CPT is a registered trademark of the American Medical Association. Check current CPT guidance, your Medicare Administrative Contractor (MAC) and each payer's policy before you change billing.

Frequently asked questions

What are the billing requirements for CPT 99490?

CPT 99490 requires a patient with two or more chronic conditions expected to last at least 12 months that put them at significant risk, documented consent, an initiating visit for new patients or those not seen in a year, a comprehensive care plan, and at least 20 minutes of clinical staff time directed by the billing practitioner in the calendar month. Each further 20 minutes is reported with add-on code 99439.

What is the difference between 99490 and 99491?

Both are non-complex chronic care management codes. 99490 counts the first 20 minutes of clinical staff time directed by the billing practitioner, while 99491 counts the first 30 minutes the physician or other qualified health care professional spends personally. They cannot be reported for the same patient in the same calendar month. Their add-ons are 99439 (20 minutes) and 99437 (30 minutes).

Can CCM and TCM be billed in the same month?

Yes. CMS's current CCM booklet says CCM codes 99487, 99489, 99490 and 99491 may be reported for services furnished during the 30-day transitional care management period, provided time and effort are not counted twice. The practitioner who bills APCM for the patient that month cannot bill either CCM or TCM for that patient in the same month.

Does a patient have to consent to CCM every month?

No. Written or verbal consent is needed once, before CCM is billed, and must be documented in the medical record with the required explanations: availability, cost sharing, one billing practitioner per month and the right to stop. A new consent is needed only if the patient switches to a different practitioner for CCM.

Who can perform chronic care management services?

Physicians, nurse practitioners, physician assistants, clinical nurse specialists and certified nurse-midwives can bill CCM. Clinical staff, whether employees or contractors, can furnish the clinical staff codes incident to the billing practitioner under general supervision, within state law and scope of practice. The billing practitioner does not need to be physically present.

Related reading

• How To Automate Care Management With AI Agents
• How To Scale ACO Operations With the Care Team You Already Have
• Pre-visit planning for value-based care: what to prepare

Source notes

CMS Medicare Learning Network, MLN909188 (June 2025): Chronic Care Management Services. https://www.cms.gov/files/document/chroniccaremanagement.pdf

CMS (last updated August 16, 2022): Frequently Asked Questions About Practitioner Billing for Chronic Care Management Services. https://www.cms.gov/files/document/chronic-care-management-faqs.pdf

CMS: Care Management. https://www.cms.gov/medicare/payment/fee-schedules/physician/care-management

Federal Register, 89 FR 97710 (December 9, 2024): CY 2025 Payment Policies Under the Physician Fee Schedule, final rule. https://www.federalregister.gov/documents/2024/12/09/2024-25382/medicare-and-medicaid-programs-cy-2025-payment-policies-under-the-physician-fee-schedule-and-other

Federal Register, 91 FR 43842 (July 16, 2026): CY 2027 Payment Policies Under the Physician Fee Schedule, proposed rule. https://www.federalregister.gov/documents/2026/07/16/2026-14327/medicare-and-medicaid-programs-cy-2027-payment-policies-under-the-physician-fee-schedule-and-other

About the author

Jay Chowdappa, MD is co-founder and CEO of Zynix AI. He is a physician, and ACOs led by him generated $300M+ in shared savings before he started Zynix AI to help care teams follow through on what their data already shows.