CPT 99490: Chronic Care Management — First 20 Minutes.
CPT 99490 covers non-face-to-face chronic care management services provided by clinical staff under the general supervision of a physician or other qualified healthcare professional. It reimburses the first 20 minutes of clinical staff time per calendar month spent on care coordination, medication reconciliation, care plan development, and communication with other providers for Medicare patients with two or more chronic conditions expected to last at least 12 months.
Quick Answer
What is CPT 99490?
CPT 99490 is the Medicare billing code for Chronic Care Management (CCM), covering the first 20 minutes of clinical staff time per calendar month for patients with two or more chronic conditions. It reimburses approximately $62 per month under the 2026 Medicare fee schedule. Clinical staff perform care coordination, medication reconciliation, and care plan management under physician supervision. Patients must have at least two chronic conditions expected to last 12 months, and documented consent is required before billing.
Documentation
Documentation requirements.
Documented patient consent for CCM services (verbal or written) with date obtained
Comprehensive, person-centered care plan addressing all chronic conditions
Identification of at least two chronic conditions expected to last 12+ months that place the patient at significant risk
Time log with date, duration, and description of each CCM activity totaling 20+ minutes
Medication reconciliation and review documentation
Record of coordination activities with other providers, pharmacies, or community services
Scenarios
Common billing scenarios.
Standard monthly CCM for diabetic patient with hypertension
BillableA clinical staff member spends 25 minutes during the month coordinating care for a patient with Type 2 diabetes and hypertension — reviewing lab results, updating the care plan, and calling the patient to discuss medication adherence.
Patient with only one chronic condition
Not BillableA patient has well-controlled hypertension as their only chronic condition. The practice provides 20 minutes of care coordination. Because the patient does not have two or more qualifying chronic conditions, 99490 cannot be billed.
CCM with RPM in same month
BillableA patient with CHF and COPD receives CCM care coordination (25 minutes) and RPM monitoring (blood pressure, weight). Both 99490 and RPM codes can be billed, but the time must be tracked separately and cannot overlap.
Only 15 minutes of clinical staff time logged
Not BillableClinical staff spent 15 minutes on care coordination for the month but did not reach the 20-minute minimum. The practice cannot bill 99490 because the time threshold was not met.
FAQ
Common questions about CPT 99490.
What is CPT 99490?
CPT 99490 is the Medicare billing code for Chronic Care Management (CCM) services — specifically the first 20 minutes of clinical staff time per calendar month spent on non-face-to-face care coordination for patients with two or more chronic conditions expected to last at least 12 months. It covers activities like care plan development, medication reconciliation, and provider coordination.
How much does CPT 99490 reimburse in 2026?
CPT 99490 reimburses approximately $62 per patient per month under the 2026 Medicare Physician Fee Schedule. The exact rate depends on geographic adjustments (GPCI) applied to the national rate. Additional revenue can be earned by billing add-on code 99439 for each additional 20 minutes of clinical staff time.
Who can bill CPT 99490?
The billing provider must be a physician or qualified healthcare professional (NP, PA, CNS). However, the clinical work — care coordination, medication reconciliation, and care plan management — can be performed by clinical staff (RNs, MAs, care coordinators) under the general supervision of the billing practitioner. The physician does not need to personally perform the 20 minutes of service.
What are the time requirements for CPT 99490?
CPT 99490 requires a minimum of 20 minutes of clinical staff time per calendar month. The time can be accumulated across multiple activities throughout the month — it does not need to be a single continuous session. Each activity must be logged with date, duration, and description. If less than 20 minutes is spent, the code cannot be billed.
Can 99490 and 99491 be billed in the same month?
No. CPT 99490 (standard CCM, clinical staff time) and 99491 (complex CCM, physician time) are mutually exclusive for the same patient in the same calendar month. Choose 99490 when clinical staff provide the care coordination, or 99491 when the physician personally provides substantial care management for medically complex patients.
What chronic conditions qualify for CPT 99490?
Any chronic condition expected to last 12 months or longer that places the patient at significant risk of death, acute exacerbation, or functional decline qualifies. Common examples include hypertension, diabetes, heart failure, COPD, chronic kidney disease, depression, and arthritis. The patient must have at least two qualifying conditions.
Related Codes
Other CPT codes.
RPM Device Supply (16+ Days)
$52.11 • Monthly (per 30-day period)
RPM Clinical Review (First 20 Min)
$51.77 • Once per calendar month
RPM Initial Setup (One-Time)
$21.71 • One-time per episode of care
RPM Clinical Review (Additional 20 Min)
$41.42 • Monthly (per calendar month, add-on to 99457)
Complex CCM Initial 30 Minutes
$86.00 • Once per calendar month
PCM Physician Base (30 Min)
$88.00 • Once per calendar month
BHI Care Management (20 Min)
$53.00 • Once per calendar month