Chronic Care Management
A monthly non-face-to-face service for patients with two or more chronic conditions, covering care planning, 24/7 access, and coordination between visits.
What it is
Chronic Care Management (CCM) pays for the clinical staff and practitioner time spent managing a patient's care outside of office visits, for patients with two or more chronic conditions expected to last at least 12 months (or until death) that put them at significant risk of death, acute exacerbation, decompensation, or functional decline.
The code family splits into non-complex CCM (99490, 99439, and the physician/QHP-time equivalents 99491, 99437) and complex CCM (99487, 99489), which is distinguished primarily by moderate-to-high complexity medical decision making and a higher, 60-minute time threshold, not by how extensively the care plan itself is revised that month. A one-time add-on, G0506, pays for extra work at the visit that formally initiates CCM.
Who qualifies
- Patient has two or more chronic conditions expected to last at least 12 months or until death
- Those conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline
- Patient gives consent (verbal is acceptable, must be documented) to receive CCM on a monthly basis, understanding any applicable cost-sharing, and can stop the service at any time
- Only one practitioner or practice can bill CCM for a given patient in a given month
Codes at a glance
| Code | What it covers | Threshold | Approx. payment | Details link |
|---|---|---|---|---|
| 99490 | Non-complex CCM, first 20 minutes of clinical staff time, per calendar month | 20 minutes clinical staff time | ~$66 | Details → |
| 99439 | Non-complex CCM add-on, each additional 20 minutes (up to 2 units per month) | Each additional 20 minutes | ~$50 | Details → |
| 99491 | Non-complex CCM, first 30 minutes of physician/QHP time, per calendar month | 30 minutes physician/QHP time | ~$89 | Details → |
| 99437 | Non-complex CCM add-on, each additional 30 minutes of physician/QHP time | Each additional 30 minutes physician/QHP time | ~$63 | Details → |
| 99487 | Complex CCM, first 60 minutes of clinical staff time, per calendar month | 60 minutes clinical staff time, moderate-to-high complexity decision making | ~$144 | Details → |
| 99489 | Complex CCM add-on, each additional 30 minutes | Each additional 30 minutes | ~$78 | Details → |
| G0506 | Comprehensive care plan, initiating visit add-on (billed once) | Billed once, at the visit that establishes CCM | ~$66 | Details → |
Approximate CY2026 Medicare Physician Fee Schedule national non-facility payment benchmark for non-QP clinicians, before geographic, sequestration, and claim-specific adjustments. Actual reimbursement varies by locality, practitioner status, payer, and billing circumstances. Verify the applicable amount with CMS or your Medicare Administrative Contractor.
What's required to bill
- Documented patient consent to CCM, including any applicable cost-sharing
- A comprehensive, patient-centered care plan, created or revised and shared with the patient and care team, accessible electronically
- 24/7 access to the care team for urgent chronic care needs, including continuity with a designated care team member
- Management of care transitions between providers and settings
- Coordination with home- and community-based clinical service providers
- An initiating visit for new patients, or those not seen by the billing practitioner within the past year
- Only one practitioner bills CCM per patient per calendar month
Documentation checklist
- Signed or verbally-documented CCM consent in the chart
- A written, current care plan accessible to the whole care team
- Time log showing clinical staff time (99490/99439/99487/99489) or physician/QHP time (99491/99437) for the month
- Evidence of 24/7 access capability and care coordination activity performed during the month
- For complex CCM (99487/99489): documentation supporting moderate-to-high complexity medical decision making and the 60-minute (or greater) time threshold; the care plan itself only needs to be established, implemented, revised, or monitored that month, a substantial rewrite isn't required
Common billing mistakes
- More than one practitioner or practice billing CCM for the same patient in the same month
- Billing complex CCM (99487) without medical decision making that actually supports moderate-to-high complexity
- Billing the add-on code (99439, 99489, or 99437) without first meeting the base code's time threshold
- No documented consent, or no accessible written care plan
- Mixing clinical staff time and physician/QHP time under the wrong code family (99490/99439 vs. 99491/99437)
- Billing CCM and APCM concurrently for the same patient and period
FAQ
Can CCM be billed alongside Advanced Primary Care Management (APCM)?
No. APCM incorporates the same underlying service elements as CCM, so CMS does not permit billing both concurrently for the same patient during the same period.
What's the difference between non-complex and complex CCM?
Complex CCM (99487/99489) is distinguished primarily by moderate-to-high complexity medical decision making and a higher, 60-minute time threshold. Since a 2020 CMS policy change, the care-planning element is satisfied whenever the care plan is established, implemented, revised, or monitored, it doesn't require a substantial rewrite of the plan that month. Non-complex CCM (99490/99439, or the physician-time equivalents 99491/99437) doesn't require that level of decision making and starts at a lower time threshold.
Can more than one doctor bill CCM for the same patient?
No. Only one practitioner or practice may bill CCM for a given patient in a given calendar month, even if the patient sees multiple specialists.
Is a face-to-face visit required to start CCM?
An initiating visit is required for new patients, or for patients the billing practitioner (or another practitioner in the same practice) hasn't seen within the past year. G0506 pays for the extra work of establishing the comprehensive care plan at that visit.