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What Is Care Management? A Guide for Physician Practices
The Medicare programs that pay for care between visits, who bills them and which combine in one month.
Short answer: Care management is the work of assessing a patient’s needs, keeping a care plan and following up between visits. It includes medication review, referrals and follow-up after an emergency visit or discharge. For Medicare practices, services such as chronic care management (CCM) and principal care management (PCM) have specific eligibility and billing rules.
Health plans, hospitals and physician practices use care management for their own programs. This guide focuses on the Medicare Part B services a physician practice can bill under its own NPI. Companian runs chronic care management services for practices nationwide.
CMS’s CCM booklet groups six services together: CCM, PCM, principal illness navigation (PIN), community health integration (CHI), TCM and advanced primary care management (APCM). Their patient requirements and billing units differ; the catalogue below compares them.
TL;DR: care management in Medicare, in five lines
What it is: Part B services for work between visits, most of them billed monthly.
Who bills: the practice, under its own license.
Who does the work: under the CY2026 rules, clinical staff, employed or contracted, under the practitioner’s general supervision.
What the patient does: consents (once for CCM); the usual Part B cost sharing applies.
The rule that trips practices: a minute counts toward one code only.
What care management means for a physician practice
For a physician practice, care management starts with an eligible patient, consent and a care plan. Between visits, the care team may:
- Review medications and potential interactions.
- Arrange recommended preventive services and referrals.
- Follow up after an emergency visit or discharge.
- Coordinate with the patient’s other providers.
CMS describes CCM as non-face-to-face services, delivered by phone, secure message and work in the record. The billing practitioner directs the work.
How a care management program works month to month
Before the first month: the initiating visit and consent
Before the first CCM month, check two separate requirements:
- Initiating visit: required for a new patient or one the billing practitioner has not seen within the past year. It may be a comprehensive face-to-face E/M visit, annual wellness visit or initial preventive physical examination, billed separately; CCM must be discussed.
- Consent: documented once for CCM. PIN has a different rule: consent is renewed annually.
The CCM eligibility and consent guide lists what the patient must be told.
Examples of care management between visits
Each program pays for a different kind of work:
- CCM or PCM: clinical staff review a medication change, arrange a preventive service that is due or follow up after an emergency department visit.
- PIN: certified or trained auxiliary personnel help a patient with one serious, high-risk condition through system navigation, care coordination and health education.
- CHI: auxiliary personnel, such as a community health worker, address an upstream driver that significantly limits diagnosis or treatment of the problem raised at the initiating visit.
- TCM: the practitioner’s team manages the 30 days that start when a patient is discharged from an inpatient stay.
Who provides care management and who bills for it
The billing practitioner directs care management and bills for it. For CCM, that practitioner may be a physician, nurse practitioner, physician assistant, clinical nurse specialist or certified nurse-midwife.
- CCM and PCM: clinical staff do the monthly work.
- PIN and CHI: certified or trained auxiliary personnel, including community health workers, do the monthly work.
- Under the CY2026 rules, clinical-staff CCM codes carry general supervision. Staff work incident to the practitioner’s services, subject to state law, licensure and scope of practice.
Under the CY2026 rules, those staff need not be employees: CMS’s FAQ allows clinical staff from an outside company when every incident-to rule is met, and says that with little oversight or no clinical integration the practitioner should not bill. Only the supervising practitioner may bill Medicare for incident-to services. How these rules apply to your practice is for your billing practitioner, your MAC and your counsel to confirm.
Medicare care management programs
Each program has its own patient test and its own billing unit.
| Program | Patient requirements | Billing unit |
|---|---|---|
| CCM (99490, 99439) | Two or more chronic conditions expected to last 12 months or until death, with significant risk | 20 minutes of clinical staff time; 20-minute add-ons |
| PCM (99426, 99427) | One high-risk chronic condition expected to last at least 3 months | 30 minutes of clinical staff time; 30-minute add-ons |
| PIN (G0023, G0024) | One serious, high-risk condition needing a disease-specific care plan | 60 minutes by certified or trained auxiliary personnel; 30-minute add-ons |
| CHI (G0019, G0022) | Upstream drivers significantly limiting diagnosis or treatment | 60 minutes by certified or trained auxiliary personnel; 30-minute add-ons |
| TCM (99495, 99496) | A patient discharged from an inpatient stay | One 30-day period from discharge |
| APCM (G0556 to G0558) | Primary care patients, in three levels by chronic conditions and QMB status | Monthly; no minutes counted |
The chronic care management guide covers CCM in full, and APCM vs CCM vs PCM works through which program fits which patient.
What the patient pays
Care management carries the usual Part B cost sharing:
- In 2026, the Part B deductible is $283 and coinsurance is 20 percent. Patients without supplemental coverage may owe part of the monthly charge.
- A Medigap insurer cannot deny coinsurance it owes on a covered Part B service.
- CMS cannot waive care-management cost sharing. Routine practice waivers raise federal fraud-and-abuse issues; ask counsel.
- Without CCM consent, neither Medicare nor the patient can be billed.
Care management mistakes that cost a billable month
Four beliefs that lose a billable month
“A short month still bills.” 99490 needs at least 20 minutes of clinical staff time in the calendar month. A PCM month under 30 minutes cannot be billed.
“Any check-in call counts.” For CCM, only time spent by clinical staff or the billing practitioner, for a consented patient, counts; a call by other staff does not count toward 99490 or 99439.
“One call can count for two programs.” A minute counted toward one billed code cannot count toward another; PIN or CHI can run alongside CCM or PCM only when the time is kept separate.
“Consent has to be taken at the initiating visit.” The two are separate requirements; consent, written or verbal, can be obtained after the visit.
Offering care management without adding staff
The guide to outsourcing chronic care management compares contracted clinical staff, allowed under the CY2026 rules, with hiring. Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.
Companian supports advanced primary care management (APCM) for partner practices; the practice bills G0556, G0557 and G0558 under its own NPI.
Each enrolled patient has one dedicated Care Advocate, the same person every time, from a care team of registered nurses, nurse practitioners, licensed clinical social workers and care companions. Gloria, an AI assistant, handles documentation and prepares pre-visit summaries. Care management for physician practices sets out which tasks Companian’s team handles and which stay with your practice.
Key takeaways
- Medicare care management is a family of Part B services for work between visits, billed by the practice.
- CCM covers two or more chronic conditions expected to last at least 12 months with significant risk; PCM covers one high-risk condition expected to last at least 3 months.
- Under the CY2026 rules, employed or contracted clinical staff work under the practitioner’s general supervision.
- The usual Part B deductible and 20 percent coinsurance apply.
- A minute of staff time counts toward one billed code only.
Questions about Medicare care management
What is care management in healthcare?
Care management in healthcare is the work of keeping a patient with chronic or complex conditions on a care plan between visits: assessing needs, reviewing medications, coordinating with other providers and following up after an emergency visit or a discharge. Health plans, hospitals and physician practices each run it; for a practice billing Medicare, it means Part B services, such as chronic care management and principal care management, that the practice bills for its own patients.
Does Medicare cover care management?
Yes. Medicare Part B pays for chronic care management (CCM), principal care management (PCM) and the other care management services under the Physician Fee Schedule, and the practice bills for them.
Does every Medicare patient qualify for care management?
Not for chronic care management (CCM) or principal care management (PCM). CCM needs two or more chronic conditions expected to last at least 12 months or until death with significant risk, and PCM one high-risk condition expected to last at least 3 months. APCM is broader: its first level covers patients with one chronic condition or fewer, billed by the practitioner responsible for all their primary care.
Can care management be done over the phone?
Yes. CMS describes chronic care management (CCM) as non-face-to-face services, and its FAQ says principal illness navigation (PIN) and community health integration (CHI) can be delivered using telecommunications technology.
How long does a patient stay in a care management program?
Chronic care management (CCM) runs month to month while the patient remains eligible and consented. The patient can stop at any time, effective at the end of the calendar month. Principal care management (PCM) needs a new initiating visit after one year.
What is a care management program?
In a physician practice, a care management program is the practice’s system for delivering a Medicare care management service: identifying eligible patients, taking consent, assigning a care team member and counting staff time each month. The billing practitioner directs it and bills for it.
Medicare care management covers the Part B services physician practices bill, including chronic care management (CPT 99490 and 99439) and principal care management (CPT 99426 and 99427). Companian works with physician practices on CCM and PCM: your team refers; Companian handles enrollment, outreach and documentation; your practice bills monthly under its own license.
Sources
- CMS, Chronic Care Management Services (MLN909188), June 2025
- CMS, FAQs on Practitioner Billing for CCM
- CMS, FAQ on CHI and PIN services, March 2026
- Federal Register, CY 2024 PFS final rule
- Federal Register, CY 2025 PFS final rule
- Federal Register, CY 2026 PFS final rule
- eCFR, 42 CFR 410.26
- CMS, MM14279, CY 2026 Part B deductible and coinsurance
- 42 U.S.C. 1320a-7a(i)(6), civil monetary penalties, definition of remuneration
Read more: What is chronic care management? · APCM vs CCM vs PCM · PCM codes 99426 and 99427
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See how Companian runs chronic care management for practices nationwide. Your practice bills Medicare under its own NPI.