CCM Billing Codes for 2026: 99490, 99439, 99487, 99489, 99491

Updated October 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

Medicare pays for chronic care management through six main CPT codes: 99490 and 99439 for clinical staff time, 99491 and 99437 for time the billing practitioner personally spends, and 99487 and 99489 for complex CCM. The right code depends on who did the work, how many minutes you logged in the calendar month, and the medical decision making involved. In 2026, 99490 pays about $66.13 nationally.

Key facts

• CCM is monthly care management for patients with two or more chronic conditions expected to last at least 12 months, per the CMS Medicare Learning Network booklet on CCM.
• 99490 covers the first 20 minutes of clinical staff time in a calendar month, and 99439 adds each further 20 minutes.
• 99491 requires at least 30 minutes of the billing practitioner's own time, and 99437 adds each further 30 minutes. Clinical staff time doesn't count toward either one.
• 99487 covers the first 60 minutes of complex CCM with moderate or high complexity medical decision making, and 99489 adds each further 30 minutes.
• You can't report standard CCM and complex CCM for the same patient in the same calendar month, per the CMS MLN booklet.
• The 2026 non QP conversion factor is $33.40, set in the CY 2026 Physician Fee Schedule final rule.
• The CY 2027 proposed rule would bar contractor staffing for RPM and RTM only. CCM isn't part of that proposal, according to the CMS CY 2027 proposed rule fact sheet.

Which CCM code do I bill?

You pick the code from two questions: who did the work, and did the case need complex decision making. If your clinical staff did the work under your supervision, you use 99490, plus 99439 for more time. If you did it yourself, you use 99491 and 99437. If the month demanded moderate or high complexity decision making and a new or substantially revised care plan, you use 99487 and 99489.

Here's the code by code list, using the descriptors in the CMS booklet:

• 99490: first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
• 99439: add on to 99490, each additional 20 minutes of clinical staff time.
• 99491: at least 30 minutes of the physician or other qualified professional's own time, per calendar month.
• 99437: add on to 99491, each additional 30 minutes of the practitioner's own time.
• 99487: complex CCM, first 60 minutes of clinical staff time, with moderate or high complexity medical decision making.
• 99489: add on to 99487, each additional 30 minutes of clinical staff time.

Most practices live in the first group. That's because clinical staff time is cheaper than practitioner time, and the codes were designed around it.

What is the difference between 99490, 99491 and 99487?

The difference is whose time counts and how hard the medical decision making is. 99490 counts clinical staff time, and CMS also lets the billing practitioner's own time count toward it when that time isn't used to report 99491. 99491 counts only the practitioner's personal time. 99487 counts clinical staff time but also requires moderate or high complexity decision making by the billing practitioner.

CMS spells out the supervision level too. The codes describing clinical staff activities (99487, 99489, 99490 and 99439) are assigned general supervision under the fee schedule. That means the practitioner directs the work and keeps overall control, but doesn't need to be in the room.

The complexity piece of 99487 is the part people miss. The decision making can't be subcontracted to anyone else, and CMS says the practitioner must personally perform it during the service period. So complex CCM isn't just "a longer month." It needs a patient whose care plan truly had to be built or substantially revised, and a chart that shows it.

How do the add on codes work?

An add on code only exists next to its base code, and it only starts counting once you've cleared the base threshold. 99439 stacks on 99490 for every additional 20 minutes. 99437 stacks on 99491 for every additional 30. 99489 stacks on 99487 for every additional 30.

Be careful with the base codes themselves. CMS says 99490 and 99491 describe a minimum number of minutes with no maximum, so you bill one unit and one line item per calendar month, not one unit per 20 minutes. Extra time goes on the add on code, not on extra units of the base.

Timing of the claim matters too. For 99490, 99439, 99491 and 99437, CMS says you can report the claim after you reach the time threshold, and you don't have to hold it until the end of the month. Complex CCM is different: CMS says to report 99487 and 99489 at the conclusion of the service period, because the code includes decision making that's determined by the problems you addressed across the whole month.

Here's a simple way to track it. Log each patient's minutes by date, tag each entry with who did it, and review the running total weekly. A practice that waits until the 30th to find out a patient sits at 14 minutes has already lost the month.

Which CCM codes can you bill together in the same month?

Within CCM, you pick one lane per patient per month. You can't report standard and complex CCM in the same calendar month, and CMS says not to report 99491 or 99437 in the same month as 99487, 99489, 99490 or 99439. Only one practitioner can bill CCM for a patient in a given month, so the consent conversation matters.

Outside CCM, CMS lists several rules in the booklet:

• You can't bill CCM during the same service period as home health supervision (G0181), hospice supervision (G0182) or certain ESRD services (CPT 90951 to 90970).
• You can report CCM during the 30 day transitional care management period (99495 and 99496).
• You can't report complex CCM and prolonged evaluation and management services in the same month.
• You can't count the same minutes toward CCM and toward any other billed code.
• You can bill remote physiologic monitoring or remote therapeutic monitoring alongside CCM, but not both of them at once.

Advanced primary care management is a separate question, and it has its own rules. We cover it in why APCM and CCM can't be billed together.

What has to happen before you bill any CCM code?

Three things come before the first claim: an initiating visit when required, documented patient consent, and a comprehensive electronic care plan. CMS requires an initiating visit for new patients or patients you haven't seen in the past year. It has to be a comprehensive face to face visit, an annual wellness visit or an initial preventive physical exam, and CCM has to be discussed there.

Consent can be written or verbal, but it has to be documented. You tell the patient CCM is available, that cost sharing may apply, that only one practitioner can bill CCM in a month, and that they can stop at any time, effective at the end of the calendar month. Patients give consent once unless they switch to a different CCM practitioner. Our full checklist is in CCM consent and care plan requirements.

The care plan is the third piece. It should be patient centered and electronic, built on an assessment and an inventory of resources and supports, and available promptly inside and outside the practice. CMS also expects 24/7 access to care and a designated care team member for continuity.

If you want the full pillar overview, start with what chronic care management is.

How much does one CCM code pay in 2026?

The 2026 national non facility payment for 99490 is $66.13 a month, before the adjustment for your locality. That figure comes from the relative value units and the $33.40 conversion factor in the 2026 final rule. Your actual payment varies by locality, and patients owe the usual Part B cost sharing unless they have supplemental coverage.

Here's a worked example with the arithmetic shown line by line. It's an illustration, not a forecast:

1. One patient, billed 99490 for 12 months: 12 x $66.13 = $793.56.
2. A panel of 100 patients who all stay enrolled all year: 100 x $793.56 = $79,356.
3. The same panel with 25 patients leaving after month three: 75 x $793.56 = $59,517, plus 25 x 3 x $66.13 = $4,959.75, for a total of $64,476.75.

The third line is the point. Retention moves revenue as much as enrollment does. The numbers also leave out staff cost, software, phone time and denied claims, so treat them as a ceiling, not a margin.

What this means for your practice

Start by deciding which lane your patients fit. Most will sit in standard CCM billed with 99490 and 99439. Reserve complex CCM for the patients whose month really needed a new or substantially revised plan, and bill 99491 only when you personally do the work.

Then fix the plumbing before the volume. Build a minute log that shows who did what and when, a consent template that covers the five elements CMS lists, and a monthly check that catches patients sitting just under 20 minutes.

On staffing, CCM can still use clinical staff working under your general supervision, and the CY 2027 contractor proposal doesn't change that for CCM as written. Watch the final rule, which usually lands in early November.

At HANA Health, we build tools that help practices run the outreach and documentation around care management programs. You can read more at HANA for practices.

Frequently asked questions

Can I bill 99490 and 99491 in the same month for one patient?

No. CMS says not to report 99491 in the same calendar month as 99490. If you personally do the work, you can count your time toward 99490 or apply it to 99491, but not both.

Does the 20 minutes have to be one phone call?

No. The 20 minutes is cumulative time across the calendar month. Only clinical staff time counts, and each activity has to fall under the CCM service elements. Time can't also be counted toward another billed service.

Can I bill CCM right after a hospital discharge?

Yes. CMS says you can report 99487, 99489, 99490 and 99491 during the 30 day transitional care management period. The minutes still can't be double counted.

Do I need a visit before I start CCM?

Only for new patients or patients you haven't seen in the past year. In that case, CMS requires an initiating visit where CCM is discussed. G0506 can be billed once with that visit if you do extensive assessment and care planning beyond the usual effort.

Does AI time count toward my CCM minutes?

CMS hasn't issued guidance saying it does. Today the minutes that count are clinical staff time under supervision and, for some codes, the practitioner's own time.

Sources

1. Centers for Medicare & Medicaid Services, Medicare Learning Network, Chronic Care Management Services (MLN909188), June 2025.
2. Centers for Medicare & Medicaid Services, Chronic Care Management Frequently Asked Questions.
3. Centers for Medicare & Medicaid Services, Frequently Asked Questions about Physician Billing for Chronic Care Management Services, 2019 update.
4. Centers for Medicare & Medicaid Services, CY 2026 Medicare Physician Fee Schedule Final Rule fact sheet, October 2025.
5. Centers for Medicare & Medicaid Services, CY 2027 Medicare Physician Fee Schedule Proposed Rule fact sheet, July 2026.

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 talk through your care management program, book a discovery call.