Chronic care management CPT codes for 2026

CCM CPT codes cover managing two or more chronic conditions expected to last at least 12 months or until death, with significant risk of death, acute worsening or functional decline. Choosing the code also requires a comprehensive care plan and the right type of documented time.

Start with who performed the work and which service requirements the practice met. A longer time log alone does not establish complex CCM, and a diagnosis list alone does not establish eligibility.

CCM CPT codes at a glance

Use this table to distinguish the three code pathways before reviewing a monthly record. These are summaries of CMS descriptions, not a replacement for the service requirements.

Code	Pathway	Time	Additional requirement or pairing
99490	Clinical staff, directed by physician or other qualified health professional	At least 20 minutes	Comprehensive care plan and qualifying chronic conditions
99439	Additional clinical-staff CCM	Each additional 20 minutes	Add-on to 99490
99487	Complex CCM	First 60 minutes of clinical staff time	Moderate or high complexity medical decision making
99489	Additional complex CCM	Each additional 30 minutes	Add-on to 99487
99491	Personally furnished practitioner CCM	At least 30 minutes	Only the billing practitioner’s personal time
99437	Additional personally furnished CCM	Each additional 30 minutes	Add-on to 99491

The 99490 guide explains the clinical-staff base service, and the 99439 guide explains its additional-time code. Read the complex CCM guide for the decision-making requirement and the 99491 guide for personally furnished care, including its 99437 add-on.

Who qualifies before CCM codes apply

The billing practitioner must establish more than a count of chronic diagnoses. The conditions must meet the duration and risk criteria, and the practice must establish, implement, revise or monitor a comprehensive care plan.

• Confirm two or more chronic conditions expected to last at least 12 months or until death.
• Record the significant clinical risk that makes ongoing management appropriate.
• Connect the work to a comprehensive care plan that addresses the patient’s needs.

Before starting CCM for a new patient or one not seen within the previous year, the billing practitioner must furnish an initiating visit. CMS allows a comprehensive face-to-face evaluation and management visit, an annual wellness visit or an initial preventive physical exam; that visit is separately billable.

The practice must also obtain and document written or verbal consent before billing. The discussion covers availability, possible cost sharing, the single billing practitioner for each calendar month and the patient’s right to stop, effective at month end.

Consent generally needs to be obtained once, with a new consent when the patient changes billing practitioners. A patient who declines has not authorized a billable CCM service, even if staff have already spent time making contact.

How to choose CCM CPT codes month to month

1. Identify whose time is in the record

CMS permits the clinical-staff code family to include time spent directly by the billing practitioner as well as qualifying clinical staff. Practitioner time cannot also be used to report 99491; the personally furnished pathway excludes clinical staff time.

Ask the billing team to distinguish the person performing the activity from the person directing care. Keeping those roles visible prevents a combined total from being mistaken for a personal-time total.

2. Confirm the pathway and the work

For complex CCM, the billing practitioner must perform moderate or high complexity medical decision making. Reaching the complex time threshold does not substitute for that requirement, so route any proposed change of pathway to the practitioner before submitting the claim.

3. Reconcile the calendar-month total

The CCM service period is one calendar month. CGS Administrators, a Medicare contractor, states that 99439 may be used up to twice per month; CMS originally established that cap for its predecessor, G2058.

As a threshold illustration, 20 eligible minutes support the 99490 time requirement, while 40 eligible minutes meet the base plus one additional-time threshold. At 60 eligible minutes, the base plus two additional-time thresholds are met; all other service requirements still apply.

4. Check conflicts before submission

1. Confirm the patient’s consent, eligibility and care plan in the practice record.
2. Remove any time already counted toward another billed service.
3. Check whether another care-management code conflicts for this practitioner and month.
4. Have the billing practitioner resolve missing clinical information before the billing team submits.

CMS permits claims for the non-complex pathways once the applicable time threshold has been met. Complex CCM is reported at month end; the practice should reconcile the month’s work before choosing that pathway.

What the time log must sit alongside

A time total is only one part of CCM. CMS expects the scope-of-service elements to be routinely furnished unless a particular element is not medically indicated or necessary.

• An electronic comprehensive care plan based on the patient’s needs, resources and supports, made promptly available inside and outside the billing practice, with a copy for patients and caregivers when necessary.
• Core patient information, including medications and allergies, recorded in certified electronic health record technology.
• Continuity with a designated care team member and ways to communicate between visits.
• Access to physicians, other qualified practitioners or clinical staff for urgent needs at all hours.
• Medication review, care coordination and follow-up during care transitions when indicated.

The urgent-access requirement is 24 hours a day, 7 days a week. Your practice should specify how that obligation is covered rather than treating a routine monthly call as the access arrangement.

CMS assigns the clinical-staff CCM codes to general supervision: the billing practitioner retains overall direction and control without needing to be physically present during the service. Applicable state law, licensure and scope-of-practice requirements still apply to work furnished incident to the practitioner.

External clinical staff may furnish the clinical-staff portion when all incident-to and CCM rules are met. CMS cautions that little practitioner oversight or poor clinical integration can mean CCM has not actually been furnished; a staffing arrangement does not transfer the practitioner’s responsibility.

CCM code combinations and common misreadings

Check the broader claim record as well. CMS bars CCM during the same service period as G0181, G0182 and certain end-stage renal disease services in the 90951 through 90970 range; complex CCM also cannot be reported with prolonged evaluation and management services in the same month.

CCM carries the usual Medicare Part B deductible and coinsurance. Explain possible patient responsibility before the patient agrees, rather than assuming every patient has supplemental coverage.

Where CCM sits beside other programs

Principal care management focuses on one high-risk chronic condition expected to last at least three months. The same practitioner cannot bill PCM and CCM for the same patient in the same month; different practitioners may do so for different conditions, with separate care plans.

Advanced primary care management is another monthly approach. A practitioner billing APCM cannot also bill CCM for that patient in the same month; another practitioner may furnish a medically necessary separately billable service.

Principal illness navigation and community health integration can be furnished alongside CCM when each service’s requirements are met, the services are reasonable and necessary, and time and effort are not counted twice. Those rules require separate attention to the work actually performed.

Transitional care management concerns a discharge-related service period. CMS allows medically necessary TCM and CCM concurrently, but the same minutes cannot be counted toward both; that permission does not remove either program’s requirements.

Set responsibilities before starting monthly care

For a practice assessing chronic care management services, start with patient eligibility, the practitioner’s responsibilities and the monthly record the billing team needs. Agree which team members’ time counts toward each code in your services agreement.

Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”

Key takeaways

• The CCM family has clinical-staff, complex and personally furnished pathways.
• Clinical-staff time does not count toward 99491 or 99437.
• Complex CCM requires the billing practitioner’s moderate or high complexity medical decision making.
• A CCM calendar month must meet consent and scope requirements as well as time thresholds.
• The same minute cannot support CCM and another billed service.

Frequently asked questions about ccm cpt codes

Which CCM code family uses only the billing practitioner’s time?

99491 and its 99437 add-on count only time personally spent by the billing practitioner. Clinical staff time cannot be added to reach those thresholds.

Does 60 minutes automatically make a CCM month complex?

No, complex CCM also requires moderate or high complexity medical decision making by the billing practitioner. The time threshold alone does not establish that clinical requirement.

Can the CCM base and add-on come from different calendar months?

The CCM service period is a calendar month, and the add-on describes additional time within that month. Reconcile each month separately against the applicable base and add-on requirements.

Who states the two-use monthly limit for 99439?

CGS Administrators states that 99439 may be used up to twice per month. CMS established the cap for predecessor G2058, which 99439 replaced with an identical descriptor.

Does CCM consent need to be renewed every month?

CMS requires consent once before CCM starts, rather than each month or year. A change in the billing practitioner requires a new consent.

Can an outside care team replace the billing practitioner’s involvement?

No, CMS requires the billing practitioner to retain involvement in CCM. External clinical-staff arrangements must meet incident-to requirements and preserve oversight and clinical integration.

Medicare Part B chronic care management uses CPT 99490 and 99439 for clinical-staff care, 99487 and 99489 for complex care, and 99491 and 99437 for practitioner-personal care in physician practices. Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”

Read more: CCM base service · Additional clinical-staff time

Rates & disclosures

National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing.

This guide summarizes CMS rules for practices nationwide and is not legal or billing advice.