99490
Chrnc care mgmt staff 1st 20
Chronic Care Management (CCM) services, at least 20 minutes of clinical staff time directed by a physician or QHP per calendar month. CMS 2026 wRVU 1.00. Initial billable threshold for monthly CCM; add 99439 for each additional 20 minutes (up to two additional units).
A patient discharged from the hospital can trigger both chronic care management and transitional care management. Since 2020 Medicare allows both in the same month. Here is how to bill both without a denial, and when to pick one.
When to use it
Use 99490 for monthly chronic care management of a patient with two or more chronic conditions expected to last 12 or more months or until the patient's death, and at significant risk of death, acute exacerbation, or functional decline. The 20-minute threshold is cumulative across the calendar month and covers clinical staff time (medical assistant, RN, LPN) directed by the billing provider.
Full guidance
Activities counted: care plan review, care coordination with other providers, medication reconciliation, prescription refills, patient or family phone calls, lab and imaging review, social work coordination, behavioral health coordination. The work is non-face-to-face; do not count the time of any face-to-face encounter with the patient that month.
Documentation checklist
- ✓Comprehensive care plan documented in the chart, addressing each chronic condition.
- ✓Patient consent obtained and documented. Consent can be verbal or written; document the date and method.
- ✓20 minutes of non-face-to-face clinical staff time, summed across the calendar month.
- ✓Activity log: each activity dated, with duration, content, and the staff member who performed it.
- ✓Only one practitioner may bill CCM for a given patient in a given calendar month.
- ✓CCM may be billed in the same month as TCM (99495 or 99496) since 2020, but the same minutes cannot count toward both services; keep separate time logs.
- ✓G0506 (initial care planning) may be billed once at CCM initiation.
Common pitfalls
- !Counting face-to-face encounter time toward the 20-minute threshold. CCM is explicitly non-face-to-face; office visit time does not count.
- !Only one practitioner can bill CCM per month per patient. If you and a specialist both attempted to bill CCM in the same month, the claim with the later date typically gets denied.
- !Patient cost share. Medicare CCM has a copay; some patients will object. Document consent including the cost share disclosure.
- !Double-counting time across TCM and CCM in a post-discharge month. Billing both is allowed (CMS lifted the old prohibition in 2020), but each service needs its own exclusive, separately logged minutes.
- !Failing to maintain an activity log. CMS audits CCM aggressively; without a contemporaneous log of staff time, the claim is indefensible.
- !Counting time of clinical staff who are not directly supervised by the billing provider. CCM requires general supervision (incident-to-style billing rules).
Payer notes
Medicare and Medicare Advantage plans cover CCM with a patient copay. Some MA plans waive the copay as a value-based-care benefit. Commercial payers generally do not cover 99490 (Medicare-only code); commercial CCM equivalents vary by plan. Document patient consent including any cost share each calendar year, not just at initiation.