CCM Billing: Chronic Care Management Codes, Guidelines and 2026 Rates

Mukesh MakwanaFounder & CEO · Hands-on medical billing & RCM across 11 specialties · Reviewed November 1, 2026

Chronic care management (CCM) is monthly, mostly non-face-to-face care for a patient with two or more chronic conditions expected to last at least 12 months or until death. Medicare pays for it under CPT codes 99490, 99439, 99491, 99437, 99487 and 99489, based on who did the work and how many minutes it took in the calendar month. The 2026 national non-facility rate for the most common code, 99490, is $66.13 before the patient's cost sharing and geographic adjustment.

Want CCM running in your practice?

If you are a physician, practice owner or office manager with Medicare patients who have two or more chronic conditions, your team may already be doing unpaid work between visits. Let us know and we will set up the billing side of CCM for your practice: which patients to review, consent wording, a monthly time log, the right codes and the claim process. Your clinicians keep caring for the patients.

CCM billing codes and 2026 national Medicare rates

These are national amounts, calculated by multiplying each code's total relative value units in the CMS 2026 relative value file by the 2026 conversion factor of $33.4009. Your actual payment changes with your locality; check it in the CMS Physician Fee Schedule Look-Up Tool.

The + marks an add-on code, billed only with its base code. Medicare's Medically Unlikely Edits (fourth quarter 2026) allow 2 units a day each for 99439 and 99437.

Worked example: clinical staff spend 45 documented minutes on one eligible patient in a month in a physician office. That supports 99490 plus one unit of 99439, a national total of $116.57 before adjustment. The last 5 minutes do not reach another 20-minute block, so they are not billed.

Nurse practitioners and clinical nurse specialists: under 42 CFR 414.56, Medicare's allowed amount for their services may not exceed 85 percent of the physician fee schedule amount, so their rate can be lower than the table.

Who can bill CCM, and who pays

According to the CMS CCM booklet (MLN909188), physicians (MD and DO), certified nurse-midwives, clinical nurse specialists, nurse practitioners and physician assistants may bill CCM. Primary care practitioners bill it most often, but some specialists do too. Clinical psychologists, podiatrists and dentists cannot, because CCM is outside their scope; they can still be consulted or receive referrals.

Clinical staff can do the work under the billing practitioner's direction on an incident-to basis, subject to state law, licensure and scope of practice. CMS assigns 99490, 99439, 99487 and 99489 general supervision, so the practitioner does not need to be physically present. Only one practitioner can provide and bill CCM for a patient in a calendar month.

• Original Medicare: bill Part B. The patient owes the applicable cost sharing, which Medigap or Medicaid may help cover, as the CMS CCM FAQ explains.
• Medicare Advantage, Medicaid and commercial plans: each plan sets its own coverage, rates and rules. Verify them before enrolling the patient, because the figures here are Original Medicare amounts only.

Where to bill: claim destination and place of service

Send physician practice claims to your Medicare Administrative Contractor (MAC) on the professional claim (837P or CMS-1500). CCM is priced in both facility and non-facility settings. CMS says to report the place of service where the billing practitioner would ordinarily provide face-to-face care to the patient. That applies even when the patient lives in a skilled nursing facility, nursing facility or assisted living. So the POS on the claim, not where the phone call happened, decides which column of the table pays.

On timing, the service period is one calendar month. Complex CCM is reported at the end of the month. For 99490, 99439, 99491 and 99437 you may bill at month end or once the time threshold is met, using that date as the date of service, and CMS still expects services to continue as medically necessary.

Rural health clinics and FQHCs

RHCs and FQHCs no longer report the old combined code G0511. The CMS manual update requires the individual base and add-on codes, effective January 1, 2025. Both the RHC and FQHC booklets list the same CCM codes. Care coordination is paid at the national non-facility rate, separately from the RHC all-inclusive rate or FQHC payment.

How to start a chronic care management program in your practice

1. List your candidates. Pull Medicare patients with two or more qualifying chronic conditions.
2. Name who does the work. Decide which clinical staff log time and which practitioner bills, since that decides the code.
3. Check your systems. Confirm your certified EHR, electronic care plan and after-hours access meet the requirements below.
4. Add CCM to your visits. Discuss it at an E/M visit, wellness visit or initial preventive exam, and document consent.
5. Log minutes daily and bill monthly. Reach a code's time threshold, then bill it to your MAC.

To estimate your monthly Medicare revenue, multiply your number of enrolled patients by the rate for the code you expect to bill, then check your local rate.

CCM billing guidelines: what Medicare requires

1. Eligible patient: two or more chronic conditions expected to last at least 12 months or until death, placing the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. CMS examples include diabetes, hypertension, COPD, atrial fibrillation, depression and arthritis.
2. Initiating visit: required for new patients and those not seen within the previous year. It can be a comprehensive E/M visit, annual wellness visit or initial preventive exam, CCM must be discussed during it, and it is billed separately.
3. Consent: written or verbal, documented once, and again only if the patient changes practitioners. Cover availability, cost sharing, the one-practitioner limit and the right to stop at the end of any month.
4. Certified EHR: structured recording of demographics, problems, medications and allergies.
5. Electronic comprehensive care plan: created, revised and monitored, shared promptly inside and outside the practice, with a copy to the patient or caregiver when needed.
6. 24/7 access and continuity: a way to reach the care team for urgent needs at any hour, a designated team member for routine appointments, and non-visit channels such as a portal.
7. Care transitions: referrals, follow-up after ED visits and discharges, and shared continuity-of-care documents.

If consent or another condition of payment is missing, CMS says you cannot bill Medicare or the patient for CCM.

CCM billing rules that cause denials

• Do not report 99490 or 99439 in the same month as 99491, 99437, 99487 or 99489, and do not report 99491 or 99437 with complex CCM.
• Do not bill CCM in the same service period as G0181, G0182 or ESRD codes 90951 to 90970.
• Complex CCM and prolonged E/M services cannot share a calendar month.
• Remote monitoring is allowed with CCM, but RPM or RTM, not both.
• Minutes counted for another billed code cannot count toward CCM. When one activity helps several patients, split the time among them.
• TCM can be billed in the same period when medically necessary, without double-counting minutes.
• The same practitioner cannot bill principal care management and CCM for one patient in the same month.

Practices that also bill remote monitoring code 99457 should track those minutes separately. Keep time logs, consent and care plan dates together in the record so each claim can be supported. Our primary care billing services include this monthly work, and our denial management team works any CCM denials.

Set up CCM for your practice

Tell us your specialty, your EHR and roughly how many Medicare patients you see. Sterling Global Solution LLC will set up CCM billing for your practice and answer your questions. If you just need help with a claim or a question, please contact us.

Frequently asked questions

Sources

Centers for Medicare & Medicaid Services, Chronic Care Management Services, MLN909188, June 2025, and CCM billing FAQ; Care Management overview.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release, non-QP conversion factor $33.4009); rates calculated by Sterling Global Solution LLC as total RVU times conversion factor.
Centers for Medicare & Medicaid Services, Medicare NCCI Medically Unlikely Edits, fourth quarter 2026; Benefit Policy Manual update, Rev. 13600; MLN006398; MLN006397.
Code of Federal Regulations, 42 CFR 414.56.

CPT® is a registered trademark of the American Medical Association. Rates are Original Medicare national amounts for 2026, before geographic adjustment and payment reductions. Other payers set their own rates. Not legal advice. How we verify this guidance.

Related reading

• PCM billing. For one high-risk condition: 99424 to 99427.
• Primary care billing services. Visits, wellness and monthly care management.
• Denial management services. Working every denial before its deadline.
• Contact Sterling Global Solution LLC. Ask us about your CCM program or claims.