CCM Revenue Worked Example: What 99490 Pays a Practice a Year

Updated October 2026. Written by Matteo Grassi, cofounder of HANA Health, trained in psychology.

Chronic care management (CCM) revenue is the monthly Medicare payment a practice earns for coordinating care between visits. At the 2026 national rate of $66.13 for code 99490, one enrolled patient who stays all year is worth $793.56 in allowed amounts. A practice's total depends on how many patients it enrolls and how long they stay.

I've watched practices guess at this number for years, and guessing usually leads to either overpromising or never starting. So here's the arithmetic, line by line, using only public numbers. Every input is a number you can swap for your own.

Key facts

• 99490 pays a $66.13 national amount in 2026 for the first 20 minutes of clinical staff time in a month, and 99439 pays $50.44 for each additional 20 minutes. The amounts come from the CMS CY2026 relative value files at a $33.4009 conversion factor.
• In 2019, just 4.0% of Medicare fee for service beneficiaries who were potentially eligible for CCM received any CCM, according to the ASPE and NORC analysis for PTAC.
• In the same analysis, 5.2% of practices with eligible patients billed CCM for at least one of them, and those practices billed it for an average of 30.7% of their potentially eligible patients.
• CCM use among patients 65 and older with two or more chronic conditions rose from 1.1% in 2015 to 3.4% in 2019, per Jang et al., Journal of the American Geriatrics Society, 2024.
• Nearly 1 in 5 CCM recipients didn't continue after the initial service, and 46.6% of recipients in 2019 received it for three months or less (same study).
• Only one practitioner can bill CCM for a patient in a calendar month, and patient cost sharing applies, per the CMS Medicare Learning Network CCM booklet.

What does one CCM patient pay a practice in a year?

One patient who receives 20 minutes of qualifying clinical staff time every month generates 12 x $66.13 = $793.56 in Medicare allowed amounts at the national rate. That's the floor for a full year of 99490.

Here's the line by line version:

1. Base month: 99490 at $66.13.
2. Month with 40 qualifying minutes: 99490 plus one unit of 99439 = $66.13 + $50.44 = $116.57.
3. Full year at 20 minutes a month: 12 x $66.13 = $793.56.
4. Full year at 40 minutes a month: 12 x $116.57 = $1,398.84.

Both amounts come straight from CMS relative value units. For 99490, the non facility total is 1.98 RVUs, and 1.98 x $33.4009 = $66.13. For 99439 it's 1.51 RVUs, and 1.51 x $33.4009 = $50.44.

Two cautions. First, these are national allowed amounts. Your locality adjustment moves them up or down, and Medicare pays part of the allowed amount while the patient owes cost sharing. Second, the 40 minute line only works if the extra time is real, documented and clinically needed. Don't plan around it.

How many patients could a practice actually enroll?

Most practices that offer CCM enroll far fewer patients than they could. In the ASPE analysis, 22.6 million of 35.6 million fee for service beneficiaries (63.4%) were potentially eligible for CCM in 2019, and fewer than 883,000 received it.

That gap is the "revenue left on the table" people talk about. It's real, but it's smaller than it looks. ASPE decided eligibility from claims alone, which doesn't capture whether a physician would judge a patient suitable. Some of those patients wouldn't consent, wouldn't answer calls, or already get the care elsewhere.

Different studies also count differently. Jang and colleagues looked at patients 65 and older with two or more chronic conditions and found about 75% were potentially eligible. Their utilization number was 3.4% in 2019, close to ASPE's 4.0% despite the different definition.

For your own panel, count Medicare fee for service patients with two or more chronic conditions expected to last at least 12 months. The CMS booklet lists examples such as diabetes, hypertension, COPD and depression. That count is your eligible base.

What does a worked example look like?

Take a hypothetical practice with 600 potentially eligible Medicare patients and compare two enrollment levels using the public numbers above. This is arithmetic, not a forecast.

• Low enrollment (4.0%, the 2019 national rate among eligible patients): 600 x 0.040 = 24 patients. At 12 months of 99490, that's 24 x $793.56 = $19,045.44.
• High enrollment (30.7%, the average among practices that billed CCM): 600 x 0.307 = 184 patients (rounded). At 12 months, that's 184 x $793.56 = $146,015.04.
• Difference: $146,015.04 minus $19,045.44 = $126,969.60 a year in allowed amounts.

Notice what drives the result. The price per patient didn't change. The count of enrolled patients did, and then the months each patient stayed.

The 30.7% figure is a useful benchmark, not a target. It describes practices that had already chosen to bill CCM, so it's biased toward practices with working programs. A practice starting from zero shouldn't expect to jump there in a quarter.

How does retention change the math?

Retention can cut the number by half or more, because revenue is billed month by month. A patient who leaves after three months pays you 3 x $66.13 = $198.39, not $793.56.

Run the high enrollment case again with short stays. If all 184 patients left after three months, revenue would be 184 x 3 x $66.13 = $36,503.76, against $146,015.04 for a full year. Same enrollment, one quarter of the revenue.

The research suggests this isn't a far fetched scenario. In Jang's data, 46.6% of CCM recipients in 2019 received the service for three months or less, and nearly 1 in 5 didn't continue after the first service. An earlier Mathematica evaluation for CMS found about 19% of beneficiaries received only one month of CCM in the first two years of the program.

Some patients in that evaluation said they stopped after learning about the copay, which they said they weren't aware of when they gave consent. That's a consent conversation problem, not a patient problem. We cover the causes in why patients drop out of CCM.

What does this revenue not include?

These figures are allowed amounts, not profit. The worked example leaves out the cost of the staff time behind each billed month, software, supervision, billing work, denials and the share the patient owes.

You'll need your own numbers for those. A simple check: take your fully loaded cost per clinical staff hour, multiply by the minutes your team really spends per patient per month, and compare that to $66.13. Time that doesn't meet the minimum for a billable month is cost without revenue.

Also keep in mind what CMS requires before you can bill. The CCM booklet calls for an initiating visit for new patients or patients not seen in the previous year, documented consent, and a comprehensive electronic care plan. Our guide to CCM consent and care plan requirements walks through them, and the CCM billing codes guide covers which code applies when.

What this means for your practice

Do the arithmetic with your own panel before you decide anything. Three inputs matter most: how many eligible patients you have, how many you can realistically enroll and keep, and what a billable month costs you in staff time.

A short plan:

1. Count your eligible Medicare patients using the two or more chronic conditions test.
2. Pick a conservative enrollment number, then model it at 3, 6 and 12 months of stay.
3. Price your real staff minutes against $66.13 per month.
4. Check that consent, the care plan and the initiating visit are documented before the first claim.

One thing I'd stress from the clinical side is that retention is mostly a conversation. Patients stay when they understand what the monthly call is for and feel someone knows them. HANA supports practices with patient outreach by phone for care management programs, which is the part of the job that takes the most staff time. You can read more on our care coordination page.

Frequently asked questions

How much can a practice earn per CCM patient per year?

At the 2026 national rate, 12 months of 99490 is $793.56 in allowed amounts. Add a unit of 99439 each month and the figure is $1,398.84. Your locality, cost sharing and the months a patient stays will change what you collect.

Is CCM revenue profit?

No. It's the Medicare allowed amount before staff time, software, supervision and billing costs. Practices need to subtract their own costs to see margin.

What share of eligible patients does a practice need to enroll to make CCM worthwhile?

There's no public number that fits every practice. It depends on your staff cost per minute and your retention. Model your own panel at several enrollment and stay lengths before you commit.

Why is national CCM use so low if the payment is clear?

The sources don't give one answer. The ASPE report notes eligibility was based on claims alone and may overstate who's suitable, and the Jang study points to short stays as a pattern. The sources above don't measure why individual practices decline to bill it.

Do these numbers apply to Medicare Advantage?

No. They're Original Medicare fee schedule amounts. Medicare Advantage plans and commercial payers use their own contracts and policies.

Sources

1. Centers for Medicare & Medicaid Services, PFS Relative Value Files, CY2026 releases (RVU26A to RVU26D).
2. Centers for Medicare & Medicaid Services, Medicare Learning Network, Chronic Care Management Services (MLN909188), June 2025.
3. ASPE and NORC, Analysis of 2019 Medicare FFS Claims for CCM and TCM Services, prepared for PTAC, March 2022.
4. Jang J, et al., Use of chronic care management service among Medicare beneficiaries in 2015 to 2019, Journal of the American Geriatrics Society, 2024.
5. Mathematica Policy Research for CMS, Evaluation of the Diffusion and Impact of the Chronic Care Management (CCM) Services: Final Report, November 2017.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill.

Want to talk through your own panel math? Book a discovery call with HANA Health.