Quick answer
Chronic Care Management (CCM) is billed once per calendar month for patients with two or more chronic conditions. Use 99490 for the first 20 minutes of clinical staff time (+99439 for each additional 20), 99491 for the first 30 minutes of the billing practitioner’s own time (+99437 for each additional 30), or 99487 for complex CCM of at least 60 minutes of staff time (+99489 for each additional 30).
- 99437 is an add-on to 99491, not to 99490.
- Consent can be verbal or written, but it must be documented before you bill.
- CCM can be billed in the same month as TCM; it cannot be billed by the same practitioner in the same month as PCM or APCM.
Chronic Care Management is one of the most reliable recurring revenue streams in family medicine and internal medicine, and one of the most frequently denied. Most denials trace back to four things: the wrong code for whose time was spent, a time log that does not reach the threshold, missing consent or care-plan documentation, and billing a service CMS does not allow in the same month. This guide covers each one using the current CMS rules for 2026.
The CCM code family at a glance
| Code | Whose time counts | Time per calendar month | Notes |
|---|---|---|---|
| 99490 | Clinical staff (billing practitioner time also counts if not used for 99491) | First 20 minutes | Non-complex CCM |
| +99439 | Clinical staff | Each additional 20 minutes | Add-on to 99490; Medicare’s claim edit (MUE) allows up to 2 units |
| 99491 | Billing physician or other qualified health professional, personally | First 30 minutes | Cannot be performed by staff or billed incident-to |
| +99437 | Billing physician or QHP, personally | Each additional 30 minutes | Add-on to 99491 |
| 99487 | Clinical staff | First 60 minutes | Complex CCM: requires moderate- or high-complexity medical decision-making |
| +99489 | Clinical staff | Each additional 30 minutes | Add-on to 99487 |
All six codes are reported once per calendar month per patient, and only one practitioner can bill CCM for a patient in a given month. You also cannot mix families in one month: do not report 99491/99437 together with 99490/99439 or 99487/99489.
Which patients qualify for CCM?
- Two or more chronic conditions expected to last at least 12 months, or until the patient’s death.
- Conditions that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
- A comprehensive care plan that has been established, implemented, revised or monitored.
Before you bill: consent, the initiating visit, the care plan and 24/7 access
Patient consent
Consent can be verbal or written; CMS has allowed verbal consent since 2017. Whichever you use, document it in the record before the first CCM claim. Tell the patient that CCM is available, that cost-sharing may apply, that only one practitioner can bill CCM per month, and that they can stop at any time (effective at the end of that month). Consent is obtained once, and again only if the patient changes billing practitioner.
The initiating visit
New patients, and patients not seen within the past year, need an initiating visit before CCM starts: a comprehensive E/M visit, an Annual Wellness Visit, the Initial Preventive Physical Exam, or the face-to-face visit included in Transitional Care Management. CCM must be discussed at that visit. The visit itself is billed separately, and G0506 can be added once when the practitioner performs extensive assessment and care planning.
The comprehensive care plan
The care plan must be electronic, patient-centered and available promptly to everyone involved in the patient’s care, inside and outside the practice, with a copy given to the patient or caregiver. CMS expects structured recording in certified EHR technology.
24/7 access and continuity
Patients must have 24/7 access to a practitioner or clinical staff who can reach the care plan for urgent needs, plus continuity with a designated member of the care team.
99490 or 99491: which one to bill
The deciding question is whose time was spent. If nurses, medical assistants or care coordinators do most of the monthly work under general supervision, bill 99490 and add 99439 for each additional 20 minutes. If the physician or advanced practice provider personally spends at least 30 minutes on care management, bill 99491 and add 99437 for each additional 30 minutes. Time spent by the billing practitioner can count toward 99490, but the same minutes can never count toward both codes, and the two code families cannot be reported for the same patient in the same month.
When complex CCM (99487 and 99489) applies
Complex CCM requires at least 60 minutes of clinical staff time in the month plus moderate- or high-complexity medical decision-making by the billing practitioner, who must make that decision personally. Use it when the care plan is established or substantially revised that month, not for routine months. Each additional 30 minutes is reported with 99489. Prolonged E/M services cannot be billed in the same month as complex CCM.
Time logs that survive an audit
- Log every entry with the date, the minutes, who performed the work (name and credential) and what was done.
- Total the month before the claim is built. 99490 needs a full 20 minutes; 19 minutes is not billable.
- Count only care-management activity. Minutes spent on a separately billed face-to-face visit do not count.
- Never count the same minutes toward two services, such as CCM and TCM or CCM and remote monitoring.
- Keep the consent note and the current care plan in the same record as the time log.
What you can and cannot bill in the same month as CCM
| Service | Same month as CCM? |
|---|---|
| Transitional Care Management (99495, 99496) | Yes. CCM can be billed during the TCM period, without double-counting minutes. |
| Principal Care Management (99424–99427) | Not by the same practitioner. A different practitioner may bill PCM for a different condition with its own care plan. |
| Advanced Primary Care Management (G0556–G0558) | Not by the same practitioner. A different practitioner, including one in the same practice, may bill CCM when medically necessary. |
| Remote monitoring (RPM or RTM) | Yes, either RPM or RTM (not both) alongside CCM. |
| Home health / hospice care plan oversight (G0181, G0182) | No. |
| ESRD monthly services (90951–90970) | No. |
| Prolonged E/M services | Not with complex CCM (99487/99489). |
CCM vs. Advanced Primary Care Management (APCM)
Since January 1, 2025, Medicare pays Advanced Primary Care Management (G0556, G0557, G0558) as a monthly, non-time-based code for practices that take on the full primary care relationship: G0556 for patients with zero or one chronic condition, G0557 for two or more, and G0558 for Qualified Medicare Beneficiaries with two or more. The same practitioner cannot bill APCM and CCM for a patient in the same month. For 2026, CMS added three APCM behavioral health add-on codes, G0568, G0569 and G0570, which are reported with the APCM base code without counting minutes. Practices already running CCM at scale should model both options before switching.
What does CCM pay in 2026?
Under the 2026 Medicare Physician Fee Schedule, 99490 carries 1.98 non-facility RVUs. At the 2026 conversion factor of $33.4009, that is about $66 nationally before your local geographic adjustment (slightly more at the $33.5675 conversion factor for qualifying APM participants). CMS also exempted time-based care management codes from the 2026 efficiency adjustment applied to many other services.
The most common CCM denials and how to prevent them
- Consent not documented before the first claim: add a consent template to the enrollment workflow.
- Time under threshold: total minutes before billing and hold the claim if 20, 30 or 60 minutes were not reached.
- Wrong code family: 99490 and 99491 billed in the same month, or 99437 attached to 99490.
- Conflicting service: PCM or APCM billed by the same practitioner in the same month.
- No initiating visit for a new patient or one not seen in the past year.
CCM billing support for family practice and internal medicine
AMS Solutions runs CCM as part of family practice medical billing and revenue cycle management and internal medicine billing: enrollment and consent tracking, monthly time totals, code selection and same-month conflict checks before the claim goes out. See also our guide to billing Annual Wellness Visits, a common CCM initiating visit.
Frequently Asked Questions
Is 99437 an add-on to 99490?
No. 99437 is an add-on to 99491 and reports each additional 30 minutes of the billing practitioner’s own time. The add-on to 99490 is 99439, for each additional 20 minutes of clinical staff time.
Does CCM require written consent?
No. Verbal or written consent is acceptable, but it must be documented in the medical record before CCM is billed.
Can you bill CCM and TCM in the same month?
Yes. Medicare allows CCM to be billed during the TCM period, as long as the same minutes are not counted toward both services.
Can the same practice bill CCM and APCM for one patient?
Not by the same practitioner in the same month. CMS allows a different practitioner, including one in the same practice, to bill CCM when it is medically necessary.
