AI Agent Time and CCM Minutes: What Medicare Counts in 2026

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

No. CMS has issued no guidance saying AI agent time counts toward Chronic Care Management (CCM) minutes, and its published rules count only clinical staff or billing practitioner time. CCM is a monthly Medicare service for patients with two or more chronic conditions. In 2026, CPT 99490 pays $66.13 nationally for the first 20 minutes of clinical staff time in a calendar month.

Trained in psychology, I'd put it simply: a minute counts when a trained person is using judgment on a patient's behalf.

Key facts

• Time codes pay for people. CMS describes 99490 as at least 20 minutes of clinical staff time directed by a physician or other qualified professional per calendar month (CMS CCM FAQ, 2022).
• Only clinical staff time counts. CMS says other staff may help facilitate CCM, but only clinical staff time can be counted toward the minimum (CMS CCM FAQ, 2022).
• General supervision applies. CMS assigns 99490, 99439, 99487 and 99489 general supervision under the Physician Fee Schedule (CMS MLN booklet, June 2025).
• No double counting. Time counted toward CCM can't also count toward any other billed code (CMS MLN booklet, June 2025).
• The 2026 rate. 99490 carries 1.98 total non facility RVUs, and at the 2026 conversion factor of $33.4009 that gives $66.13, our arithmetic from the fee schedule files (CMS CY 2026 PFS final rule).
• CMS is asking about technology. The CY2027 proposed rule seeks comment on the payment implications of technology in primary care, and proposes no AI payment (CMS fact sheet, July 2026).
• Uptake is low. In 2019, 4.0% of potentially eligible fee for service beneficiaries received CCM (ASPE and NORC, 2022).

What counts as CCM time under Medicare rules today?

Clinical staff time and billing practitioner time count. Software time doesn't appear anywhere in CMS's description of the service. The CCM codes that describe staff activity, 99490 and its add on 99439, plus complex CCM codes 99487 and 99489, are built around people.

CMS refers practices to the CPT definition of "clinical staff" and adds a condition: time counts only if Medicare's incident to rules at 42 CFR 410.26 are met. That brings in supervision, state law, licensure and scope of practice.

The billing practitioner can't hand the whole service away, either. CMS says the staff time codes include ongoing practitioner work like oversight, management, collaboration and reassessment, and that work can't be delegated or subcontracted to anyone else.

A few more rules shape what you can log:

• Activity must be CCM scope. Time has to be spent on activities in the CCM scope of service, like care plan work, medication review and care coordination.
• Shared activities get split. If one activity benefits several patients, the time is split among them. Thirty minutes spent for three patients is ten minutes each.
• Location matters. CCM can't be billed when the clinical staff delivering it are outside the United States.

For the code by code detail, see our guide to CCM billing codes.

Why doesn't CMS guidance cover AI agent time yet?

CMS wrote its CCM rules when care management meant nurses and phone calls. The June 2025 CMS booklet and the CCM FAQ don't mention AI agents, automated calls or software minutes, and I couldn't find a CMS statement that says machine time counts.

That silence isn't permission. When a time based code is silent, the safe reading is the literal one: the descriptor says clinical staff time, so count clinical staff time. A claim built on the opposite reading is an audit risk you'd carry alone.

It also helps to separate two ideas that get blurred:

• Activity by a system. An automated call, a text reminder or a drafted summary is something a system did.
• Time by a person. A nurse reviewing the summary, deciding what to do and calling the patient back is clinical staff time.

The first can make the second faster. It can't replace it on the claim.

What does the CY2027 proposed rule say about technology in primary care?

It asks questions and doesn't change CCM time rules. In July 2026, CMS opened a comment solicitation on redesigning primary care payment, and one of its three topics is understanding the payment implications of including technology in primary care (CMS fact sheet).

The proposed rule was published in the Federal Register on July 16, 2026, and comments closed on September 14, 2026 (Federal Register). The final rule usually lands in early November.

What it means in practice:

• Nothing is settled. A request for comment isn't a payment policy. No AI minutes are billable because CMS asked a question.
• Watch the final rule. If CMS creates technology enabled care codes, they'd likely be separate codes, not a reinterpretation of clinical staff time.
• The contractor proposal is separate. The proposed limit on contractor arrangements applies to RPM and RTM, not CCM. We cover it in our explainer on the CY2027 contractor proposal.

I'll update this article when the final rule is out.

How can a practice use automation around CCM without billing for it?

Use automation to reduce the work around the minutes, and log only the human minutes. Software is useful for finding eligible patients, placing outreach, capturing patient replies and drafting summaries. Staff time then goes to the clinical decisions that CMS pays for.

APCM is the other lever. Advanced Primary Care Management bundles care management elements into a monthly payment that doesn't require counting minutes, per CMS's booklet. It has its own requirements, so check them before assuming it fits your population. The practical point for this question is that APCM removes the minute counting problem altogether.

A simple operating rule works well:

1. Decide in writing that only clinical staff and practitioner minutes go on the CCM time log.
2. Give staff a way to log start and stop times for each patient, each month.
3. Treat automated outputs as inputs to review, not as time.
4. Keep the CCM scope of service visible so staff can tell which activities qualify.
5. Audit a sample of monthly logs for time that isn't clearly human.

What does a compliant monthly time log look like?

It lists the human activity, the person, and the minutes. Here's a worked example for one patient in one month, with the arithmetic shown line by line.

• Day 3: Nurse reviews an automated call summary and flags a missed dose. 4 minutes.
• Day 3: Nurse calls the patient to follow up on the missed dose. 9 minutes.
• Day 12: Front desk staff schedules a lab visit. 0 minutes, because the CMS FAQ counts only clinical staff time.
• Day 17: Nurse updates the care plan after the specialist's note arrives. 5 minutes.
• Day 24: Nurse coordinates with the specialist's office on a medication change. 4 minutes.
• Automated calls placed by software: 0 minutes counted.

Total countable time is 4 + 9 + 5 + 4 = 22 minutes. That meets the 20 minute threshold for 99490, which pays $66.13 nationally in 2026.

Add 18 more clinical staff minutes and you reach 40 minutes, enough for one unit of 99439. With 1.51 total RVUs at $33.4009, that add on works out to about $50.44. The same patient would then total about $116.57 for the month, before locality adjustment.

Whether a nurse's review of an automated summary counts depends on it being a documented CCM scope activity done by clinical staff. When in doubt, ask your MAC.

What this means for your practice

Count people, document the minutes, and treat software as support. That keeps your CCM claims aligned with what CMS has actually published.

Start with a one page policy for your team that says which minutes count, who logs them and where. Then check your current logs for any entry that reads like system activity. If your program uses outside clinical staff, review the incident to rules for outside staff before you rely on them. And if you're new to the service, our CCM guide covers eligibility, consent and the care plan.

At HANA, we build automated patient outreach that supports care teams, so staff spend their billable minutes on clinical work, and we don't count machine time as billable. You can read more about HANA's remote care management approach.

Frequently asked questions

Can an AI phone call count as one of the 20 minutes?

Not on the guidance CMS has published. The descriptor says clinical staff time, and CMS says only clinical staff time counts toward that minimum. Count the nurse's follow up, not the machine's call.

Does a nurse's review of an AI summary count?

It can, if the review is clinical staff time spent on a CCM scope activity and you document it. The review is human judgment applied to the patient's care. The summary itself isn't time.

Is there a CMS rule that bans AI in CCM?

I found no CMS rule that bans it, and no rule that allows machine minutes either. Using automation for outreach and drafting is a workflow choice. Billing machine time is the part that lacks support.

Will the CY2027 final rule change this?

It could, though the proposed rule only asks for comment on technology in primary care and doesn't propose AI minutes. Read the final rule in early November, then check your MAC's guidance.

What if I don't want to count minutes at all?

Look at APCM. CMS's booklet says its bundled services don't require counting minutes per month. It has its own service elements, so confirm that your patients and workflows fit.

Sources

1. Centers for Medicare & Medicaid Services, Medicare Learning Network. Chronic Care Management Services (MLN909188), June 2025. cms.gov
2. Centers for Medicare & Medicaid Services. Frequently Asked Questions About Practitioner Billing for Chronic Care Management Services, updated August 2022. cms.gov
3. Centers for Medicare & Medicaid Services. CY 2026 Physician Fee Schedule Final Rule (CMS-1832-F), published November 2025. cms.gov
4. Centers for Medicare & Medicaid Services. Fact Sheet: Calendar Year 2027 Medicare Physician Fee Schedule Proposed Rule, July 2026. cms.gov
5. Federal Register. Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule (CMS-1848-P), July 16, 2026. federalregister.gov
6. ASPE and NORC. Analysis of 2019 Medicare Fee for Service Claims for CCM and TCM Services, 2022. aspe.hhs.gov

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 care management for your practice, book a discovery call.