What Is Chronic Care Management (CCM)? A 2026 Guide

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

Chronic care management (CCM) is a Medicare Part B service that pays practices to coordinate care between visits for patients with two or more chronic conditions expected to last at least 12 months. A member of the clinical staff spends at least 20 minutes a month on the care plan, medications and coordination, and the practice bills 99490, which pays $66.13 nationally in 2026.

Key facts

• CCM covers patients with two or more chronic conditions expected to last at least 12 months or until death, and that put them at significant risk of death, acute exacerbation or functional decline (CMS MLN booklet).
• 99490 pays $66.13 a month at the 2026 national non facility rate. That's 1.98 relative value units times a $33.4009 conversion factor (CMS CY 2026 fee schedule final rule).
• Patient consent is needed once, and it can be verbal (CMS CCM FAQs).
• Only one practitioner can bill CCM for a patient in a calendar month (CMS MLN booklet).
• In 2019, just 4.0% of fee for service beneficiaries who were potentially eligible received any CCM (ASPE and NORC analysis).
• Among patients who started CCM in 2019, 21.6% didn't continue after the first service (Jang et al., JAGS 2024).
• HHS OIG opened an audit of CCM payments on March 16, 2026 (OIG Work Plan).

Who is eligible for CCM?

A patient is eligible when they have two or more chronic conditions that are expected to last at least 12 months, or until death, and that put them at significant risk of death, acute exacerbation or decompensation, or functional decline. CMS lists examples such as dementia, arthritis, asthma, atrial fibrillation, cancer, cardiovascular disease, COPD, depression, diabetes, hypertension and substance use disorders. The list isn't closed.

The patient must also have Medicare Part B, and the practice needs a billing practitioner who can bill evaluation and management services. Medicare Advantage and commercial plans set their own rules, so check each contract.

Two diagnoses on a problem list aren't enough on their own. The chart should show why each condition is expected to last a year or more and how it puts the patient at risk.

What does Medicare require before you can bill CCM?

Before you bill CCM, you need an initiating visit if the patient is new or hasn't been seen in the past year, documented consent, and a comprehensive electronic care plan. Each one is a condition of payment, and each needs a note in the chart.

Here's the checklist:

1. Initiating visit. For a new patient, or one not seen within the previous year, the billing practitioner must start CCM at a comprehensive face to face visit. A level 2 to 5 office visit, an annual wellness visit or an initial preventive physical exam all count. The practitioner has to discuss CCM at that visit. The visit is billed separately and isn't part of CCM.
2. Consent. Tell the patient that CCM is available, that cost sharing may apply, that only one practitioner can bill it in a month, and that they can stop at any time, effective at the end of the calendar month. Document that you explained this and whether they accepted. Written or verbal consent works, and it's needed once unless the patient switches to a different billing practitioner.
3. Comprehensive care plan. A patient centered electronic plan based on a physical, mental, cognitive, psychosocial, functional and environmental assessment. CMS lists typical elements, including a problem list, expected outcome, measurable goals, symptom management, planned interventions, medication management, caregiver assessment and periodic review.
4. 24/7 access and continuity. The patient needs a way to reach the practice at any hour and a designated practitioner for routine follow up.
5. Care transitions and coordination. The practice manages follow up after emergency visits and discharges, and coordinates with outside clinicians and community services.

CMS calls the care plan elements "typical" rather than strict, but it expects the plan to be shared promptly and the patient to get a copy.

Which CCM code do I bill, and how much does it pay?

You pick the code by who does the work and for how long. Clinical staff time is billed with 99490 and 99439, practitioner time with 99491 and 99437, and complex CCM with 99487 and 99489. The codes are monthly, and you can't mix the three families in one month.

• 99490: first 20 minutes of clinical staff time in a calendar month. $66.13 national payment in 2026.
• 99439: each additional 20 minutes of clinical staff time, added to 99490.
• 99491: first 30 minutes of time spent personally by the physician or other qualified practitioner.
• 99437: each additional 30 minutes of personal practitioner time, added to 99491.
• 99487: complex CCM, first 60 minutes of clinical staff time, with moderate or high complexity medical decision making by the billing practitioner.
• 99489: complex CCM, each additional 30 minutes of clinical staff time, added to 99487.

Here's the arithmetic behind the headline rate. 99490 carries 1.98 total relative value units in the office setting. Multiply by the 2026 conversion factor of $33.4009 and you get $66.13. Over 12 months of 99490 alone, that's $793.56 per patient before geographic adjustment.

Medicare pays 80 percent of the allowed amount and the patient owes 20 percent coinsurance, which is about $13 a month on 99490. That cost share is one reason patients say no, and it belongs in the consent conversation.

A few combination rules matter. You can't report non complex and complex CCM in the same month. You can report CCM during a transitional care management period. You can bill remote physiologic monitoring or remote therapeutic monitoring with CCM, but not both of them together. Advanced primary care management has its own rules, covered in why APCM and CCM can't be billed together.

Can outside staff deliver CCM?

Yes, for the clinical staff codes. CMS says a billing practitioner may arrange for clinical staff outside the practice to deliver the staff portion of CCM, as long as the incident to rules and every other billing condition are met. CCM codes for clinical staff time sit under general supervision, so the practitioner doesn't need to be in the room.

There are limits. The billing practitioner's own work, such as oversight, management and reassessment, can't be delegated or subcontracted. Complex CCM needs medical decision making by the billing practitioner personally. And 99491 and 99437 can't be furnished incident to at all. If there's little oversight or the outside team isn't clinically integrated with the practice, CMS says the practitioner shouldn't bill.

The 2027 proposed rule didn't change this for CCM. CMS proposed barring contractors only for RPM and RTM, effective January 1, 2027 if finalized (CMS fact sheet). The same rule includes a request for information on care management supervision, so it's worth watching. Our post on the CY2027 RPM and RTM contractor proposal covers the details.

Why do so many eligible patients never get CCM?

Uptake is low and retention is weaker than it looks. In 2019, 4.0% of potentially eligible fee for service beneficiaries received any CCM, and the ASPE analysis warns that claims based eligibility may overstate who is truly suitable. A separate study of beneficiaries 65 and older found use rose from 1.1% in 2015 to 3.4% in 2019.

Retention is the quieter problem. In 2019, 46.6% of recipients got the service for three months or less, and 21.6% didn't continue after the initial service. Since the conditions last a year or more, the authors read that as room to improve how CCM is delivered.

CMS has noticed too. In the CY 2027 proposed rule, as summarized by the American College of Physicians, it says uptake has been limited, and the barriers are cost sharing and documentation requirements. It's asking whether the code family should be simplified.

Here's an illustration with national rates, before locality, coinsurance and sequestration. A practice enrolls 100 patients on 99490. That's 100 times $66.13, or $6,613 a month and $79,356 over 12 months. If 22 of them stop after one month, the remaining 11 months lose 22 times $66.13 times 11, which is $16,003.

From the clinical side, a monthly call that feels like a bill rather than help is the one patients let go. What a patient gets out of the call decides whether they stay.

What is OIG looking at in CCM billing?

OIG announced an audit on March 16, 2026 (project OAS-26-09-007). It will review Part B payments for CCM that may be at risk of noncompliance with the requirement for multiple chronic conditions. OIG notes that Part B payments for CCM increased substantially from 2019 through 2024.

That puts eligibility documentation at the center. The audit hasn't reported findings. The practical read is that each CCM claim should rest on a chart that shows two or more conditions, their expected duration, and the risk they carry.

Time tracking is the other soft spot. Time counts toward only one billed service, and only clinical staff time counts toward the staff codes. Keep a log that shows who did what, when and for how long.

What this means for your practice

Start with the patients you already know. Pull a list of those with two or more chronic conditions, confirm each had a qualifying visit in the past year, and record consent. Build the care plan once, then update it on a schedule instead of rewriting it every month.

Decide who delivers the monthly work, whether employed nurses, medical assistants or an outside team, and write down how the billing practitioner stays involved. Then track retention by month as closely as you track enrollment.

HANA Health helps practices run care management outreach between visits. You can see how at HANA Remote.

Frequently asked questions

How long does a CCM patient need to stay enrolled?

There's no minimum. Consent continues until the patient stops or changes billing practitioners, and they can stop at any time effective at the end of the calendar month. Billing each month needs the time threshold met and the service elements furnished.

Does CCM need a new consent every year?

No. CMS says consent is needed once before CCM starts and again only if the patient changes billing practitioners. Some payers and plans ask for more, so check your contracts.

Can a nurse or medical assistant deliver CCM time?

Yes, if they're clinical staff under your general supervision and incident to rules are met. Time from administrative staff doesn't count toward the staff based codes.

Can I bill CCM and a regular office visit in the same month?

Yes. The initiating visit and later visits are billed separately. What you can't do is count the same minutes toward CCM and another billed service.

Is the $66.13 rate what my practice will be paid?

Not exactly. It's the national figure before geographic adjustment. Medicare pays 80 percent and the patient owes the rest, and sequestration reduces Medicare's share. Check the CMS fee schedule lookup for your locality.

Sources

1. Centers for Medicare & Medicaid Services, Medicare Learning Network, Chronic Care Management Services (MLN909188).
2. Centers for Medicare & Medicaid Services, Chronic Care Management Frequently Asked Questions, updated 2022.
3. Centers for Medicare & Medicaid Services, Calendar Year 2026 Medicare Physician Fee Schedule Final Rule fact sheet (CMS-1832-F), 2025.
4. Centers for Medicare & Medicaid Services, Calendar Year 2027 Medicare Physician Fee Schedule Proposed Rule fact sheet, July 2026.
5. American College of Physicians, Summary of the 2027 Physician Fee Schedule Proposed Rule, 2026.
6. ASPE and NORC, Analysis of 2019 Medicare FFS Claims for CCM and TCM Services, 2022.
7. Jang JE et al., Use of chronic care management service among Medicare beneficiaries in 2015 to 2019, Journal of the American Geriatrics Society, 2024.
8. HHS Office of Inspector General, Audit of Medicare Payments for Chronic Care Management Services at Risk of Noncompliance, Work Plan, March 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'd like to talk through care management for your practice, you can book a call with Matteo.