Updated for 2026. One of the most common Chronic Care Management (CCM) questions is simple: What actually counts toward billable CCM time?
For CPT 99490, Medicare describes the service as the first 20 minutes of qualifying clinical staff time, directed by a physician or other qualified healthcare professional, during a calendar month. However, reaching 20 minutes is not enough by itself. The time should represent actual qualifying chronic care management services furnished to an eligible patient.
This guide explains practical activities that may contribute to CCM time and highlights activities practices should not automatically count.
CCM Time Requirements at a Glance
CodeWho Provides the ServiceTime99490Clinical staff under direction of physician or other qualified healthcare professionalFirst 20 minutes per calendar month99439Clinical staffEach additional 20 minutes99491Physician or other qualified healthcare professional personallyFirst 30 minutes99437Physician or other qualified healthcare professional personallyEach additional 30 minutes99487Clinical staff for complex CCMFirst 60 minutes99489Clinical staff for complex CCMEach additional 30 minutes
CMS states that CPT 99487, 99489, 99490, and 99439 may include time spent directly by the billing practitioner as well as qualifying clinical staff time. However, practitioner time used toward these services should not also be used to report CPT 99491.
1. Reviewing the Patient's Current Health Status
Ongoing review of the patient's health status may be part of CCM when it is performed as part of managing the patient's chronic conditions.
Examples may include:
- Reviewing changes in chronic-condition symptoms
- Reviewing recent clinical information
- Identifying changes that may require practitioner follow-up
- Evaluating whether care-plan interventions remain appropriate
- Reviewing information received from another member of the care team
Documentation should show how the review relates to the patient's ongoing chronic care rather than simply recording that a chart was opened.
2. Medication Management
Medication management is one of the most common CCM activities.
Qualifying work may include:
- Reviewing the patient's medication list
- Medication reconciliation
- Identifying possible adherence concerns
- Following up about medication use
- Coordinating prescription-related issues with the practitioner
- Communicating clinically relevant medication information to another provider
- Updating the care plan following medication changes
Example
A care manager speaks with a patient who reports not taking a prescribed blood-pressure medication because of dizziness. The care manager documents the concern, communicates it to the practitioner, and updates the patient's care-management workflow following the practitioner's response.
The qualifying care-management work associated with managing the patient's chronic condition may contribute toward CCM time when other requirements are met.
3. Care Plan Development, Monitoring and Revision
CMS identifies creation, revision, and monitoring of a comprehensive patient-centered care plan as an important component of CCM.
Activities may include:
- Reviewing care-plan goals
- Updating chronic-condition problems
- Updating interventions
- Revising patient goals
- Updating medication-management information
- Adding new specialist recommendations
- Updating caregiver or social-support information
- Documenting changes following hospitalization or another transition of care
A care plan should be individualized to the patient rather than copied forward without meaningful review.
4. Communication With the Patient
Meaningful communication with the patient related to management of chronic conditions may be part of CCM.
Examples can include:
- Discussing symptoms
- Reviewing progress toward treatment goals
- Discussing medication adherence
- Providing care-plan education
- Reviewing barriers to following the treatment plan
- Discussing recommended follow-up
- Helping the patient understand when to contact the clinical team
The communication should relate to management of the patient's chronic conditions and should be documented appropriately.
5. Communication With Caregivers
When a caregiver is appropriately involved in the patient's care, clinically relevant communication with that caregiver may be part of ongoing CCM.
For example, a caregiver may help with:
- Medication organization
- Transportation
- Home monitoring
- Appointment coordination
- Recognizing worsening symptoms
- Following the patient's care plan
Patient privacy, authorization, and other applicable requirements should always be followed.
6. Coordinating Specialist Care
CMS specifically identifies coordination with outside practitioners and resources as part of comprehensive chronic care management.
Examples may include:
- Coordinating with a cardiologist
- Following up on an endocrinology referral
- Communicating relevant patient information to a specialist
- Reviewing specialist recommendations as part of the CCM workflow
- Helping incorporate specialist recommendations into the patient's comprehensive care plan
Example
A patient with diabetes and chronic kidney disease sees both an endocrinologist and a nephrologist. The CCM team reviews relevant recommendations, coordinates follow-up, and updates the patient's comprehensive care plan.
7. Managing Referrals
AAFP identifies management of referrals to other providers among services that can be documented as part of CCM.
Referral-related care-management work may include:
- Identifying a clinically appropriate referral based on the care plan
- Coordinating referral information
- Following up on clinically relevant referral status
- Obtaining information necessary for ongoing care management
- Incorporating the specialist's recommendations into the care plan
Purely administrative scheduling activity should not automatically be treated as billable CCM time simply because it involves an appointment.
8. Managing Care Transitions
Care-transition management is another important CCM service element.
Examples include chronic-care management work following:
- Emergency-department visits
- Hospital admissions
- Hospital discharge
- Skilled nursing facility discharge
- Home-health transitions
- Changes between specialists or care settings
Relevant activities may include reviewing updated information, reconciling medications, updating the comprehensive care plan, and coordinating necessary follow-up.
9. Coordinating Home and Community Services
Managing chronic conditions often involves resources outside the physician's office.
Depending on the patient's needs, qualifying coordination may involve:
- Home health
- Physical therapy
- Occupational therapy
- Pharmacy services
- Community support programs
- Transportation resources
- Nutrition services
- Social services
The activity should be relevant to implementing or managing the patient's comprehensive care plan.
10. Addressing Social and Functional Barriers
CMS's comprehensive care-management framework includes assessment of medical, functional, and psychosocial needs.
CCM work may therefore include clinically relevant activities addressing barriers such as:
- Transportation problems interfering with treatment
- Medication affordability concerns
- Food insecurity affecting the patient's treatment plan
- Mobility limitations
- Caregiver limitations
- Difficulty understanding care instructions
- Home-safety concerns
The documentation should connect the activity to the patient's chronic-condition management and care plan.
11. Following Up on Tests and Clinical Recommendations
When performed as part of chronic-condition management, follow-up related to testing or clinical recommendations may contribute to the CCM workflow.
Examples may include:
- Following up when recommended laboratory work has not been completed
- Coordinating clinically necessary testing
- Reviewing whether planned chronic-care interventions were completed
- Escalating clinically significant findings to the appropriate practitioner
Simply receiving an automated result should not automatically be counted as CCM time. The activity should involve actual qualifying care-management work.
12. Patient Education Related to the Care Plan
Patient education may be part of CCM when it supports implementation of the comprehensive care plan.
Examples may include education about:
- Medication adherence
- Blood-pressure monitoring
- Diabetes self-management
- Recognizing warning symptoms
- Following the agreed treatment plan
- Using available care-team resources
Activities That Should Not Automatically Be Counted
Not every action involving a CCM patient should automatically be added to the monthly time total.
Opening or Reviewing a Chart Without a CCM Purpose
Merely opening the patient's record does not by itself establish a qualifying CCM service.
Routine Administrative Scheduling
Simple appointment scheduling or clerical work should not automatically be treated as clinical CCM time unless the activity meets the requirements for the reported service.
Automated Messages With No Qualifying Care-Management Work
An automated reminder alone should not automatically generate CCM time simply because it was sent to an enrolled patient.
Waiting Time
Time spent waiting for a patient or provider response should not be added simply because a task remained open.
Duplicated Documentation
The same activity should not be counted multiple times merely because it appears in several parts of the medical record.
Time Billed Under Another Service
The same time and work should not be counted toward two separately billed services when Medicare rules prohibit duplicate time reporting.
Can Physician Time Count Toward CPT 99490?
Yes, in certain circumstances. CMS states that CPT 99487, 99489, 99490, and 99439 include qualifying time spent directly by the billing practitioner as well as clinical staff time.
However, CMS also states that practitioner time used toward those codes cannot also be counted toward CPT 99491.
This is why practices need clear time-tracking rules that identify who performed each activity and which service the time supports.
99490 vs 99491
Feature9949099491Primary time sourceClinical staff directed by physician/QHP; qualifying practitioner time may also contributePhysician or other qualified healthcare professional personallyInitial monthly threshold20 minutes30 minutesClinical staff time counts?YesNo
How to Document CCM Time
A good CCM time record should allow a reviewer to understand what service was actually performed.
Consider documenting:
- Date of service
- Patient
- Staff member or practitioner
- Start and stop time or documented duration according to your organization's policy
- Description of the care-management activity
- Chronic condition or care-plan issue addressed
- Clinical outcome or next action
- Communication with patient, caregiver, practitioner, or outside provider when relevant
Example CCM Time Entry
8 minutes: Care manager reviewed patient's current medication list after cardiology visit, identified a medication change, confirmed current use with patient, updated comprehensive care plan, and notified primary practitioner of patient-reported dizziness.
This is more useful than documenting only: 8 minutes CCM.
Monthly CCM Time Example
ActivityTimeMedication review and patient follow-up7 minutesSpecialist coordination and care-plan update6 minutesPatient discussion regarding symptoms and treatment goals8 minutesTotal21 minutes
If the patient and service meet all other applicable Medicare requirements, the documented qualifying monthly time may support evaluation of CPT 99490.
CCM Time Tracking Checklist
- Confirm the patient is eligible for CCM.
- Document required consent.
- Maintain a comprehensive patient-centered care plan.
- Record only actual qualifying care-management activity.
- Identify who performed each service.
- Document the purpose of the activity.
- Record qualifying time accurately.
- Do not count waiting time.
- Do not automatically count purely clerical work.
- Avoid duplicate time across separately billed services.
- Review total qualifying time before claim submission.
- Verify current CMS, CPT, MAC, and payer requirements.
How ChronicSync Can Help
Manual CCM time tracking can become difficult as a practice enrolls more patients and multiple team members perform care-management activities throughout the month.
ChronicSync helps care teams organize chronic-care workflows, maintain clearer activity records, track patient follow-up, and improve visibility into monthly care-management work.
Start your ChronicSync Free Pilot and explore a more organized approach to Chronic Care Management.
Frequently Asked Questions
What activities count toward CPT 99490?
Qualifying CCM activities may include chronic-condition management, medication management, care-plan work, patient and caregiver communication, referral management, care coordination, care-transition work, and ongoing review of patient status when performed as part of the CCM service.
Does chart review count toward CCM time?
Clinically relevant review performed as part of managing the patient's chronic conditions may be part of CCM. Simply opening or passively reviewing a chart should not automatically be counted without qualifying care-management work.
Does scheduling an appointment count toward CCM time?
Purely clerical scheduling should not automatically be counted. Care coordination associated with implementing the patient's comprehensive care plan may be different, depending on the service actually performed and applicable billing rules.
Can medication reconciliation count toward CCM?
Medication management and reconciliation performed as part of ongoing chronic care management may contribute to qualifying CCM activity when properly documented.
Can physician time count toward CPT 99490?
CMS states that qualifying billing-practitioner time may contribute to CPT 99490 and related clinical-staff CCM codes. However, the same practitioner time cannot also be used to report CPT 99491.
How many minutes are required for CPT 99490?
CPT 99490 represents the first 20 minutes of qualifying clinical-staff CCM services directed by a physician or other qualified healthcare professional during a calendar month.
Sources
- CMS Medicare Learning Network: Chronic Care Management Services
- AAFP: Chronic Care Management
- CMS: Chronic Care Management Frequently Asked Questions
This article is for educational purposes only and does not constitute medical, legal, coding, reimbursement, or billing advice. CPT, Medicare, MAC, and commercial payer requirements can change. Verify current requirements before submitting claims.