Updated for 2026. Medicare Chronic Care Management (CCM) uses several CPT codes depending on who performs the service, how much qualifying time is documented, and whether the patient receives standard or Complex CCM.
The main CCM codes are 99490, 99439, 99491, 99437, 99487, and 99489. Selecting the correct code requires more than reaching a time threshold. Practices must also support patient eligibility, consent, care planning, staff involvement, and other applicable Medicare requirements.
This guide brings the primary CCM CPT codes together in one place for 2026.
2026 CCM CPT Codes at a Glance
CPT CodeCCM TypeWho Performs the ServiceTime99490Standard CCMClinical staff under practitioner directionFirst 20 minutes99439Standard CCM add-onClinical staff under practitioner directionEach additional 20 minutes99491Practitioner CCMPhysician or other qualified healthcare professional personallyFirst 30 minutes99437Practitioner CCM add-onPhysician or other qualified healthcare professional personallyEach additional 30 minutes99487Complex CCMClinical staff under practitioner directionFirst 60 minutes99489Complex CCM add-onClinical staff under practitioner directionEach additional 30 minutes
Who Is Eligible for Chronic Care Management?
CMS generally describes CCM patients as having two or more chronic conditions that are expected to last at least 12 months, or until the patient's death, and that place the patient at significant risk of:
- Death
- Acute exacerbation
- Decompensation
- Functional decline
Having two diagnoses in the medical record does not automatically establish CCM eligibility. The patient's documented clinical circumstances should support Medicare's duration and risk requirements.
CPT 99490: First 20 Minutes of Clinical Staff CCM
CPT 99490 is the primary standard CCM code used when qualifying care-management work is performed by clinical staff under the direction of a physician or other qualified healthcare professional.
CMS lists 99490 as the first 20 minutes of qualifying CCM services during a calendar month.
Potential qualifying activities may include:
- Medication management
- Patient and caregiver communication
- Care-plan monitoring
- Care-plan revision
- Specialist coordination
- Referral follow-up
- Care-transition support
- Coordination with community resources
- Addressing barriers affecting chronic-condition management
Example
An RN care manager performs 23 minutes of qualifying CCM activities during the month, including medication-adherence review, patient follow-up, specialist coordination, and updating the comprehensive care plan.
If all other Medicare requirements are met, the practice may evaluate CPT 99490.
CPT 99439: Additional 20 Minutes of Standard CCM
CPT 99439 is the add-on code associated with CPT 99490.
CMS lists 99439 as each additional 20 minutes of qualifying standard CCM services.
It is not a stand-alone code. The applicable CPT 99490 base service must first be supported.
99490 and 99439 Structure
CodeTime99490First 20 minutes99439Each additional 20 minutes
Practices should use actual documented qualifying time and apply current CPT time-reporting rules rather than automatically rounding incomplete time periods.
CPT 99491: First 30 Minutes Personally Provided by the Practitioner
CPT 99491 represents CCM personally performed by the physician or other qualified healthcare professional.
CMS lists the code as the first 30 minutes during a calendar month.
The key difference from CPT 99490 is that clinical-staff time does not count toward the required 99491 time threshold.
Example
A physician personally spends 34 qualifying minutes during the month reviewing chronic-condition status, discussing medication adherence with the patient, reviewing specialist recommendations, and updating the comprehensive care plan.
If the other CCM requirements are satisfied, CPT 99491 may be evaluated.
CPT 99437: Additional Practitioner CCM Time
CPT 99437 is the add-on code associated with CPT 99491.
CMS identifies it as each additional 30 minutes of qualifying CCM personally performed by the physician or other qualified healthcare professional.
CodeTime99491First 30 minutes99437Each additional 30 minutes
Clinical-staff time cannot be used to meet the reporting threshold for either 99491 or 99437.
CPT 99487: Complex Chronic Care Management
CPT 99487 is the base code for Complex Chronic Care Management.
CMS lists the service as the first 60 minutes of qualifying clinical-staff Complex CCM activity during a calendar month.
Complex CCM has an important additional requirement: moderate- or high-complexity medical decision-making by the physician or other billing practitioner.
Therefore, simply accumulating 60 minutes of staff activity does not automatically support CPT 99487.
Potential Complex CCM Scenario
A patient with heart failure, COPD, chronic kidney disease, and diabetes is discharged from the hospital with significant medication changes.
The care team coordinates several specialists, performs medication reconciliation, communicates with the patient and caregiver, substantially updates the care plan, and manages new clinical concerns.
The billing practitioner also performs and documents the required moderate- or high-complexity medical decision-making.
If the qualifying time and other requirements are met, the service may support evaluation of CPT 99487.
CPT 99489: Additional Complex CCM Time
CPT 99489 is the add-on code associated with CPT 99487.
CMS's current CCM booklet identifies CPT 99489 as each additional 30 minutes of qualifying Complex CCM clinical-staff time.
CodeComplex CCM Time99487First 60 minutes99489Each additional 30 minutes
CPT 99489 should not be reported independently without the applicable base Complex CCM service.
Standard CCM vs Practitioner CCM vs Complex CCM
PathwayBase CodeAdd-OnInitial TimeClinical staff standard CCM994909943920 minutesPractitioner-performed CCM994919943730 minutesComplex CCM994879948960 minutes
The appropriate pathway should reflect the care that was actually furnished and documented during the calendar month.
Can Physician Time Count Toward CPT 99490?
Yes. CMS states that CPT 99487, 99489, 99490, and 99439 may include qualifying time spent directly by the billing practitioner in addition to qualifying clinical-staff time.
However, practitioner time used toward these codes cannot also be counted toward CPT 99491 or 99437.
Practices should therefore maintain clear records of who performed each activity and how the time was allocated.
Can 99490 and 99491 Be Billed Together?
No. CMS states that the clinical-staff CCM codes 99490 and 99439 should not be reported for the same patient in the same calendar month as practitioner-performed CCM codes 99491 and 99437.
The practice should select the CCM pathway supported by the actual services furnished.
Can Standard CCM and Complex CCM Be Billed Together?
No. CMS does not allow the standard CCM and Complex CCM code families to be reported together for the same patient during the same calendar month.
That means practices should not combine 99490 or 99439 with 99487 or 99489 for the same monthly CCM service.
Patient Consent Requirements
CMS requires informed patient consent before CCM services begin.
The consent may be verbal or written when properly documented in the patient's medical record.
The patient should be informed about:
- The availability and nature of CCM services
- Possible cost-sharing responsibilities
- The limitation that only one practitioner can furnish and bill CCM during a calendar month
- The patient's right to stop CCM services
Initiating Visit Requirement
CMS requires an initiating visit before CCM begins for a new patient or a patient who has not been seen by the billing practitioner within the previous year.
The initiating visit may occur as part of an appropriate:
- Evaluation and Management visit
- Annual Wellness Visit
- Initial Preventive Physical Examination
What About HCPCS G0506?
G0506 may be relevant when the billing practitioner performs extensive assessment and care-planning work beyond the usual effort of the qualifying CCM initiating visit.
Practices considering G0506 should review current CMS and CPT guidance carefully because it is separate from the monthly CCM time codes discussed above.
Comprehensive Care Plan
CMS identifies creation, revision, and monitoring of a comprehensive patient-centered electronic care plan as a central part of CCM.
Depending on the patient's needs, the care plan may include:
- Problem list
- Expected outcomes and prognosis
- Measurable treatment goals
- Medication management
- Symptom-management strategy
- Planned interventions
- Cognitive and functional assessment
- Psychosocial and environmental needs
- Caregiver assessment
- Coordination with outside practitioners and resources
- Periodic review and revision
Example Monthly Standard CCM Record
DateActivityStaffTimeOct 4Medication adherence reviewRN8 minOct 14Patient symptom follow-up and care-plan updateRN7 minOct 25Specialist coordinationRN8 minTotal23 min
If all applicable CCM requirements are satisfied, this record may support evaluation of CPT 99490.
Example Practitioner CCM Record
DateActivityTimeOct 6Physician reviewed treatment response and medications12 minOct 17Direct patient chronic-condition management10 minOct 27Specialist review and care-plan revision11 minTotal practitioner time33 min
If the practitioner personally performed the qualifying work and all other requirements are satisfied, this may support evaluation of CPT 99491.
Example Complex CCM Record
ActivityTimePost-discharge medication reconciliation17 minSpecialist coordination14 minPatient and caregiver communication13 minSubstantial care-plan revision11 minAdditional clinical coordination9 minTotal qualifying time64 min
If the practitioner also documents the required moderate- or high-complexity medical decision-making and all other requirements are met, CPT 99487 may be evaluated.
Can CCM and RPM Be Billed in the Same Month?
CMS permits qualifying Remote Physiologic Monitoring or Remote Therapeutic Monitoring services to be furnished concurrently with CCM when the requirements for each service are independently met.
The same time should not be used to support more than one time-based billed service.
Can CCM Be Provided During a TCM Period?
CMS states that qualifying CCM services may be reported during the 30-day Transitional Care Management period when applicable requirements for each service are satisfied.
Practices must avoid duplicate reporting of the same activity or time.
Common CCM Coding Mistakes
1. Choosing a Code Based Only on Total Minutes
Time is only one part of the service. Patient eligibility, staff type, care planning, consent, and other requirements must also be supported.
2. Combining Clinical Staff and Practitioner Time for 99491
Clinical-staff time does not count toward the required threshold for practitioner-performed CPT 99491 or 99437.
3. Billing 99439 Without 99490
CPT 99439 is an add-on code and requires the applicable base CPT 99490 service.
4. Billing 99489 Without 99487
CPT 99489 is an add-on code to the Complex CCM base service.
5. Using 99487 Based Only on 60 Minutes
Complex CCM also requires moderate- or high-complexity medical decision-making by the billing practitioner.
6. Mixing CCM Code Families
CMS restricts reporting clinical-staff, practitioner-performed, and Complex CCM code families together for the same patient and calendar month.
7. Double Counting Time
The same minutes should not be used to support CCM and another time-based service when duplicate reporting is prohibited.
8. Counting Routine Administrative Work
Routine scheduling, waiting time, or unrelated clerical activity should not automatically be included in CCM totals.
2026 CCM Pre-Billing Checklist
- Confirm two or more qualifying chronic conditions.
- Verify expected duration and clinical risk.
- Complete the initiating visit when required.
- Document verbal or written consent.
- Maintain a comprehensive patient-centered care plan.
- Document actual qualifying monthly CCM activity.
- Identify who performed each activity.
- Separate clinical-staff and practitioner time.
- Calculate qualifying monthly time accurately.
- Select 99490, 99491, or 99487 based on the documented service.
- Use 99439, 99437, or 99489 only when applicable add-on requirements are supported.
- Document required medical decision-making for Complex CCM.
- Exclude non-qualifying administrative and waiting time.
- Review duplicate time across RPM, RTM, TCM, PCM, and other services.
- Verify current CPT, CMS, MAC, and payer instructions before claim submission.
How ChronicSync Can Help
CCM billing becomes more difficult as patient volume grows and nurses, care managers, physicians, and other practitioners contribute different activities throughout the month.
ChronicSync helps practices organize Chronic Care Management workflows, maintain structured documentation, track patient activity, and improve visibility into staff and practitioner involvement.
Clear tracking can help care teams and billing teams review which CCM pathway the documentation supports before claims are submitted.
Start your ChronicSync Free Pilot and explore a more organized approach to Chronic Care Management.
Frequently Asked Questions
What are the main CCM CPT codes in 2026?
The primary Medicare CCM codes are 99490 and 99439 for standard clinical-staff CCM, 99491 and 99437 for practitioner-performed CCM, and 99487 and 99489 for Complex CCM.
What is CPT 99490?
CPT 99490 represents the first 20 minutes of qualifying standard CCM clinical-staff services during a calendar month.
What is CPT 99439?
CPT 99439 is the add-on code for each additional 20 minutes of qualifying standard CCM associated with CPT 99490.
What is CPT 99491?
CPT 99491 represents the first 30 minutes of qualifying CCM personally performed by a physician or other qualified healthcare professional.
What is CPT 99437?
CPT 99437 is the add-on code for each additional 30 minutes of practitioner-performed CCM associated with CPT 99491.
What is CPT 99487?
CPT 99487 represents the first 60 minutes of Complex CCM and requires moderate- or high-complexity medical decision-making by the billing practitioner.
What is CPT 99489?
CMS's current CCM booklet identifies CPT 99489 as each additional 30 minutes of qualifying Complex CCM clinical-staff time associated with CPT 99487.
Can 99490 and 99491 be billed in the same month?
CMS states that clinical-staff CCM codes and practitioner-performed CCM codes should not be reported for the same patient during the same calendar month.
Can standard CCM and Complex CCM be billed together?
No. CMS does not allow standard CCM and Complex CCM code families to be reported for the same patient during the same calendar month.
Sources
- CMS Medicare Learning Network: Chronic Care Management Services
- CMS: Chronic Care Management Frequently Asked Questions
- CMS: Chronic Care Management for Complex Conditions
This article is provided for educational purposes only and does not constitute medical, legal, coding, reimbursement, compliance, or billing advice. CPT, Medicare, Medicare Administrative Contractor, and commercial-payer requirements may change. Verify the current CPT code set and payer requirements before submitting claims.