Compared with doing nothing
The gap is not effort. It is hours.
Most patients who qualify for chronic care management are not enrolled anywhere. The work is already being done in your practice. It is happening in a form that cannot be billed, to a fraction of the people who qualify.
Your team reviews. Your provider signs.
Eligibility math
63% of Medicare fee-for-service patients qualify. 4% of them get it.
Chronic care management pays for the month of work that happens between visits. Most Medicare fee-for-service patients are eligible for it. Very few of them are in a program. Describe your panel and the subtraction runs in front of you.
One panel, national rates
Who qualifies, and who is actually enrolled
Two dials, one subtraction. The eligible rate and the enrolled rate are third-party market figures, attributed underneath. The only thing you supply is the size and the payer mix of your own panel.
The gap on this panel
487
patients who qualify, and are not getting it
On a panel of 2,000 where 40% is Medicare fee-for-service.
The program is not the constraint. Finding the hours to reach 487 people is.
Describe your panel
The starting panel size and payer mix are an illustrative example, not a market figure. The two rates underneath are. Move both dials to your own numbers.
This applies national rates to a panel you describe. It is an estimate of scale, not a count from your chart. The rates describe Medicare fee-for-service, so a panel weighted toward Medicare Advantage reads differently. Eligibility for any one patient still turns on two or more chronic conditions expected to last a year or longer, and on consent. HANA makes the calls. Your team reviews and attests, and nothing is billed until a person on your team approves it.
Program math
The rate is set. The enrollment is not.
Medicare sets the rate. You set how much of your eligible panel is on the program, and that is where the whole figure comes from.
One program, one month
What a month of this program comes to
Set the panel and the enrollment. The rate is the multiplier and it sits still.
$661
estimated, per month
10 of 250 eligible patients enrolled on CCM. 99490, CY2026 rate.
Eligibility is yours to count. CCM asks for this: Two or more chronic conditions expected to last a year or longer. The marks are starting points, not claims about your panel.
How the figure is built
10 enrolled patients on CCM 99490, at $66.13 each, comes to $661 a month.
$66.13
per enrolled patient, per month · Chronic Care Management · 99490 · 99439
The arithmetic
250 eligible patients4% enrolled10 on the program
10 on the program$66.13 per patient, per month$661 a month
What the code pays for. The first twenty minutes of clinical staff time in a calendar month, against a care plan the patient has consented to.
99490, national non-facility, Medicare PFS CY2026.
The 4% default: in 2019, that share of eligible Medicare fee-for-service patients was actually enrolled. Enrollment has grown since, so read it as a floor. Source: Colligan E et al., “Analysis of 2019 Medicare Fee-for-Service Claims for Chronic Care Management and Transitional Care Management Services”, NORC at the University of Chicago for HHS ASPE, March 2022..
An estimate, not a quote and not billing advice. One base code per enrolled patient per month, before add-on codes, geography, sequestration and the patient's share, and it assumes every enrolled patient bills every month, which no real month does. Check it against your MAC.
The cost of waiting
A month you do not bill is gone.
CCM is billed for a calendar month in which the work was actually done. There is no way to go back and bill January in March, because the minutes did not happen in January. So waiting does not defer this revenue. It ends it.
Per one eligible patient who is not enrolled.
| The wait | Billable months gone | Gross, per patient |
|---|---|---|
| One month“let us look at it after month end” | 1 | $66.13 |
| One quarter“next quarter, when things are calmer” | 3 | $198.39 |
| Six months“after the EHR migration” | 6 | $396.78 |
| A yearthe decision nobody made | 12 | $793.56 |
99490 at the CY2026 national non-facility amount of $66.13, before geographic adjustment. Not what you collect. | ||
A ceiling on one patient, not a forecast for a panel. It assumes a patient who would have been eligible, consented and billable from the first month. Real enrolment ramps, patients lapse, and some months miss the twenty minutes. Multiply by your own unenrolled count from the panel above.
Have a chat with HANA.
Give us your number. It calls in about ten seconds. Talk to it like a patient would, then let your team try it.
Hear Hana handle a real patient conversation.
Enter your details. Hana texts you to confirm, then calls within seconds, so you can hear it for yourself.
Questions practices ask
Before you leave it another year.
Most practices are doing a great deal of coordination that never becomes a claim, because it happens in the corridor, between visits, and nothing captures the time in a form that supports billing. The gap is usually documentation and reach rather than effort.
The figures on this page come from published third-party analysis of the Medicare fee-for-service population, cited beside the arithmetic. They describe a national picture, not your panel, which is why the dials move. Run them against your own numbers.
No, and it says so on itself. It is the published national amount before geographic adjustment, and it is not what lands in the bank: sequestration and the standard Part B patient coinsurance both come off. It is an order of magnitude, not a forecast.
The honest answer is that these are billing rules and they have to be got right. That is why nothing bills until a person on your team has read the note and approved it, and why the programme pages list the questions we will not guess at rather than answering them plausibly.
You could, and some practices should. It is worth doing the arithmetic first: a coordinator's salary against the share of the panel one person can actually reach in a month. That comparison is the one that usually decides it.
Ready when you are
Hear it make the call. Then decide.
Bring your panel numbers. We will go through which programmes your patients already qualify for, and what your team would still do.
- Your patients, your claim
- Your team reviews and attests
- Nothing bills until a person approves