CCM Billing
Chronic Care Management CPT Codes & Billing Guide 2026.
A complete breakdown of Chronic Care Management CPT codes, reimbursement rates, eligibility criteria, and documentation requirements for 2026 Medicare billing.
CPT Codes
CPT code breakdown.
Chronic Care Management — First 20 Minutes
Non-face-to-face chronic care management services for patients with two or more chronic conditions expected to last at least 12 months. Covers the first 20 minutes of clinical staff time per calendar month, directed by a physician or other qualified healthcare professional.
Frequency
Monthly (per calendar month)
Time Requirement
Minimum 20 minutes of clinical staff time per calendar month
Documentation Requirements
- Documented patient consent for CCM services (verbal or written)
- Comprehensive care plan addressing all chronic conditions
- Time log with date, duration, and description of each CCM activity
- Identification of at least two chronic conditions expected to last 12+ months
- Medication reconciliation and review documentation
- Coordination activities with other providers, pharmacies, or community services
Chronic Care Management — Each Additional 20 Minutes
Each additional 20 minutes of clinical staff time for chronic care management beyond the initial 20 minutes billed under 99490. May be billed up to two times per calendar month (for a maximum of 60 total minutes under standard CCM).
Frequency
Monthly (per calendar month, up to 2 additional units, requires base 99490)
Time Requirement
Each additional 20 minutes beyond initial 99490 time
Documentation Requirements
- Cumulative time log demonstrating total time exceeding 20-minute threshold
- Detailed description of additional care coordination activities
- Clinical justification for extended CCM services
- Updated care plan modifications as applicable
- Reference to base 99490 claim for the same billing period
Complex Chronic Care Management — First 30 Minutes (Physician-Directed)
Complex CCM services requiring substantial physician or qualified healthcare professional involvement in care management activities. Covers the first 30 minutes of direct physician/QHP time (not clinical staff time) per calendar month. Used when patients require more complex medical decision-making.
Frequency
Monthly (per calendar month)
Time Requirement
Minimum 30 minutes of physician/QHP time per calendar month
Documentation Requirements
- Documentation of medical complexity justifying physician-level involvement
- Physician/QHP personal time log (not clinical staff time)
- Comprehensive care plan with complex condition management strategies
- Evidence of substantive physician involvement in care decisions
- Medication management with complexity documentation
- Coordination notes for multi-specialty or multi-facility care
Complex Chronic Care Management — Each Additional 30 Minutes
Each additional 30 minutes of physician or qualified healthcare professional time for complex chronic care management in the same calendar month. Must be billed in conjunction with 99491 as the base code.
Frequency
Monthly (per calendar month, add-on to 99491)
Time Requirement
Additional 30 minutes of physician/QHP time
Documentation Requirements
- Cumulative physician/QHP time log exceeding initial 30 minutes
- Ongoing complexity justification documented
- Care plan revisions and clinical decisions noted
- Must be billed with 99491 as base code
Eligibility
Patient eligibility.
Patient must have two or more chronic conditions expected to last at least 12 months
Chronic conditions must place the patient at significant risk of death, acute exacerbation, or functional decline
Documented patient consent (verbal or written) must be obtained prior to or at the first CCM service
Patient must have a comprehensive, person-centered care plan established, implemented, and regularly updated
An initiating visit (Annual Wellness Visit, IPPE, or face-to-face E/M visit) must occur within the prior 12 months
Only one practitioner may bill CCM for a patient in a given calendar month
Avoid These
Common billing mistakes.
Not obtaining and documenting patient consent before billing — consent must be documented in the medical record
Overlapping CCM time with PCM time for the same patient in the same month — these services are mutually exclusive per CMS guidelines
Insufficient care plan documentation — the care plan must be comprehensive, addressing all chronic conditions, medications, and coordination needs
Failing to conduct medication reconciliation as part of CCM services
Not meeting the 20-minute minimum threshold before billing 99490
Billing 99491 (complex CCM) with clinical staff time instead of physician/QHP personal time
Not having an initiating face-to-face visit within the prior 12 months
Compliance
Compliance notes.
CCM services (99490/99439) can be furnished by clinical staff under general supervision of the billing practitioner
Complex CCM (99491) requires direct physician or QHP time — clinical staff time does not count toward this code
Only one practitioner can bill CCM for a given patient per calendar month — practices must coordinate to avoid duplicate billing
CCM and RPM can be billed concurrently, but time cannot be double-counted between programs
CCM and PCM should not be billed for the same patient in the same month
Patient consent can be verbal but must be documented in the medical record with the date obtained
Care plans must be electronically stored and available to all care team members
FAQ
Common questions.
Can CCM and RPM be billed together for the same patient?
Yes, CCM and RPM can be billed concurrently for the same patient in the same calendar month. The key requirement is that time spent on each service must be tracked separately — you cannot count the same clinical minutes toward both CCM and RPM time thresholds. For example, 20 minutes of care plan coordination counts toward CCM, while 20 minutes of reviewing RPM device data and communicating with the patient counts toward RPM.
What qualifies as a chronic condition for CCM eligibility?
Qualifying chronic conditions include any condition expected to last at least 12 months that places the patient at significant risk of death, acute exacerbation, or functional decline. Common qualifying conditions include hypertension, diabetes, heart failure, COPD, chronic kidney disease, depression, and arthritis. The patient must have at least two such conditions to qualify for CCM.
When should I bill 99491 (complex CCM) instead of 99490 (standard CCM)?
Bill 99491 when the patient's condition complexity requires substantial direct physician or qualified healthcare professional involvement — not just clinical staff oversight. Complex CCM is appropriate when patients need complex medical decision-making, management of multiple interacting conditions, or coordination across multiple specialists. The critical difference is that 99491 requires 30 minutes of physician/QHP personal time, whereas 99490 requires 20 minutes of clinical staff time under general supervision.
How often does patient consent need to be renewed for CCM?
CMS does not require annual renewal of CCM consent; once obtained, consent remains valid unless the patient revokes it. However, best practice is to confirm the patient's continued participation at least annually, typically during their Annual Wellness Visit or a comprehensive E/M visit. The initial consent must clearly inform the patient that only one practitioner can bill CCM per month and that cost-sharing may apply.
What activities count toward the 20-minute CCM time requirement?
Qualifying CCM activities include: care plan development and revision, medication reconciliation and management, communication with other treating providers, coordination with home health agencies or community services, patient or caregiver education, and assessment of psychosocial needs. Time spent on administrative tasks like scheduling or billing does not count. All activities must be documented with date, duration, and description.
More Billing Guides
Other billing guides.
RPM Billing Guide
Remote Patient Monitoring enables clinicians to monitor patient health data collected via FDA-cleared devices outside of traditional clinical settings. RPM is reimbursed through a set of CPT codes covering device setup, ongoing data transmission, and clinical time spent reviewing and acting on the data.
PCM Billing Guide
Principal Care Management provides reimbursement for care management services focused on a single high-risk chronic condition. PCM is designed for patients who need intensive management of one complex condition rather than the multi-condition coordination provided by CCM. It is particularly suited for conditions requiring frequent monitoring and treatment adjustments.
BHI Billing Guide
Behavioral Health Integration supports the assessment and management of behavioral health conditions within primary care settings through a psychiatric collaborative care model. BHI enables primary care providers to deliver behavioral health services — including depression screening, anxiety management, and substance use disorder monitoring — with psychiatric consultation support.
RTM Billing Guide
Remote Therapeutic Monitoring enables clinicians to monitor non-physiologic data such as therapy adherence, pain levels, medication response, and functional status using FDA-cleared medical devices or software. Unlike RPM (which monitors physiologic data like blood pressure and glucose), RTM is designed for respiratory, musculoskeletal, and cognitive therapy outcomes tracking.