Updated for 2026

Chronic Care Management Reimbursement Guide

Chronic Care Management is reimbursed under the Medicare Physician Fee Schedule, with a payment amount that varies by code, geography, and other factors — not one flat national number.

How Medicare Reimbursement Works

CMS pays for CCM services under the Physician Fee Schedule (PFS), which assigns a relative value to each billing code and converts it to a dollar amount using a yearly conversion factor. The PFS is updated at least annually, and CMS may revise it further through the year.

Why Rates Vary

The PFS applies a Geographic Practice Cost Index (GPCI) that adjusts payment by locality — the same code can pay a different amount in different parts of the country. Facility versus non-facility setting, and whether the billing practitioner is a physician or non-physician practitioner subject to a payment differential, can also affect the actual amount paid.

Geographic Adjustment

Because of locality adjustment, a single "national" figure is only a reference point, not a guarantee of what a specific practice will be paid. Use the CMS Physician Fee Schedule Look-Up Tool (linked below) to check the locality-adjusted amount for a specific area.

CCM Code Categories

CCM billing spans non-complex codes (99490/99439, or 99491/99437 for personally-performed time) and complex CCM (99487/99489). See our CCM CPT Codes overview for how each relates to the others.

Current Configured Rates

Code	Description	National Amount	Year	Status
99439	Chronic care management, clinical staff time, each additional 20 minutes per calendar month	$50.44	2026	Pending verification
99490	Chronic care management, clinical staff time, first 20 minutes per calendar month (general supervision)	$66.13	2026	Pending verification
99487	Complex chronic care management, clinical staff time, first 60 minutes per calendar month (requires moderate/high complexity medical decision-making)	$144.29	2026	Pending verification
99489	Complex chronic care management, clinical staff time, each additional 30 minutes per calendar month	$78.16	2026	Pending verification

National, non-facility figures with no locality adjustment. Managed in ChronicSync's admin panel — see Official Resources to verify against the live CMS Physician Fee Schedule Look-Up Tool.

Example Revenue Calculation

Example only. A practice with 300 eligible patients, 60% CCM enrollment, and a typical mix of base, additional-time, and complex CCM patients can see the resulting monthly and annual estimate using the CCM Revenue Calculator below — built on the same configured rates shown above.

Practice Cost Considerations

Reimbursement is gross revenue, not profit. Care manager staffing time, administrative overhead, and any care-management software cost all factor into a program's actual net return — the CCM Revenue Calculator's optional cost fields let you model this.

Frequently Asked Questions

No. The Medicare Physician Fee Schedule publishes a national baseline, but locality adjustment (and facility/non-facility and provider-type differences) mean actual payment varies by where and how the service is billed.

Yes. This guide describes Original Medicare's Physician Fee Schedule. Medicare Advantage plans may set their own reimbursement terms for care-management services — check with the specific plan.

They're configured in ChronicSync's admin panel from CMS Physician Fee Schedule figures and are periodically reviewed — see the verification status shown next to the rates above.

Official Resources

CMS — Chronic Care Management Services (MLN Booklet, MLN909188) — published June 2025
CMS Physician Fee Schedule Look-Up Tool
CMS — Care Management Services overview

Medicare rules and reimbursement may change. This page was last reviewed on September 30, 2026.

This tool and page are provided for educational and planning purposes only and do not constitute legal, coding, billing, financial, or medical advice. Medicare and payer requirements can change. Practices should verify current requirements and reimbursement with CMS, their Medicare Administrative Contractor, payer, coding advisor, or compliance professional.

Related Resources

CCM CPT Codes CPT 99490 Reimbursement Guide CCM Billing Requirements ChronicSync for Chronic Care Management

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