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Chronic Care Management Reimbursement 2026 by Locality
Chronic care management reimbursement starts at $66.13 nationally for 99490 in 2026 and runs from $60.71 to $83.76, depending on your Medicare payment locality.
Short answer: Medicare pays $66.13 nationally for 99490, the first 20 minutes of chronic care management, in 2026. By locality it runs from $60.71 in Arkansas to $83.76 in Alaska, and PCM code 99426 pays $67.80 nationally. Your Medicare contractor publishes the official figures for your locality.
2026 CCM and PCM reimbursement rates
All amounts are 2026 Medicare non-facility payments to a participating provider at the $33.4009 conversion factor, computed from the CMS RVU26D files. The lowest and highest columns show the range across all 109 Medicare payment localities.
Chronic care management
| Code | Service | National 2026 | Lowest locality | Highest locality |
|---|---|---|---|---|
| 99490 | CCM, clinical staff, first 20 minutes | $66.13 | $60.71 | $83.76 |
| 99439 | CCM, each additional 20 minutes | $50.44 | $46.05 | $63.45 |
| 99487 | Complex CCM, first 60 minutes | $144.29 | $130.98 | $184.06 |
| 99489 | Complex CCM, each additional 30 minutes | $78.16 | $71.04 | $99.50 |
| 99491 | CCM by the practitioner, first 30 minutes | $89.18 | $82.64 | $115.23 |
| 99437 | Practitioner, each additional 30 minutes | $63.13 | $58.13 | $80.56 |
To model your own panel, use the CCM/PCM revenue calculator for any state and locality. Each code’s requirements are in chronic care management CPT codes. Florida practices can check local fees through First Coast Medicare, the state’s Medicare contractor.
Principal care management
| Code | Service | National 2026 | Lowest locality | Highest locality |
|---|---|---|---|---|
| 99424 | PCM, practitioner, first 30 minutes | $87.51 | $80.74 | $112.38 |
| 99425 | PCM, practitioner, each additional 30 minutes | $61.46 | $56.70 | $78.78 |
| 99426 | PCM, clinical staff, first 30 minutes | $67.80 | $62.15 | $85.54 |
| 99427 | PCM, clinical staff, each additional 30 minutes | $54.11 | $49.25 | $68.64 |
Advanced primary care management
| Code | Service | National 2026 | Lowest locality | Highest locality |
|---|---|---|---|---|
| G0556 | APCM level 1 | $16.37 | $15.01 | $20.72 |
| G0557 | APCM level 2 | $53.78 | $49.24 | $67.60 |
| G0558 | APCM level 3 (QMB) | $117.24 | $107.19 | $147.06 |
| G0568 | APCM add-on, CoCM initial month | $161.66 | $146.00 | $207.73 |
| G0569 | APCM add-on, CoCM subsequent month | $145.96 | $133.31 | $183.21 |
| G0570 | APCM add-on, general BHI | $57.78 | $53.33 | $74.02 |
Navigation (PIN) and integration (CHI)
| Code | Service | National 2026 | Lowest locality | Highest locality |
|---|---|---|---|---|
| G0023 | PIN, first 60 minutes | $87.18 | $78.79 | $112.50 |
| G0024 | PIN, each additional 30 minutes | $54.44 | $49.49 | $69.23 |
| G0019 | CHI, first 60 minutes | $86.17 | $77.93 | $111.06 |
| G0022 | CHI, each additional 30 minutes | $54.11 | $49.20 | $68.75 |
Codes billed alongside care management
For reference only; Companian does not deliver these services.
| Code | Service | National 2026 | Lowest locality | Highest locality |
|---|---|---|---|---|
| 99495 | TCM, moderate complexity | $220.11 | $199.99 | $280.82 |
| 99496 | TCM, high complexity | $298.60 | $271.59 | $381.30 |
| G0438 | Annual wellness visit, initial | $174.35 | $160.06 | $220.54 |
| G0439 | Annual wellness visit, subsequent | $137.61 | $125.76 | $173.21 |
Chronic care management reimbursement by state
Each state’s median payment locality, for the four codes most CCM and PCM months use. States with one locality show the statewide rate. Larger states split by county, so check your own locality in the CCM/PCM revenue calculator.
| State | Localities | Median locality | 99490 | 99439 | 99426 | 99427 |
|---|---|---|---|---|---|---|
| Alabama | 1 | Alabama | $61.32 | $46.54 | $62.78 | $49.79 |
| Alaska | 1 | Alaska | $83.76 | $63.03 | $85.54 | $67.08 |
| Arizona | 1 | Arizona | $64.85 | $49.41 | $66.47 | $52.98 |
| Arkansas | 1 | Arkansas | $60.71 | $46.05 | $62.15 | $49.25 |
| California | 29 | San Luis Obispo-Paso Robles | $69.84 | $53.59 | $71.74 | $57.73 |
| Colorado | 1 | Colorado | $67.97 | $51.97 | $69.74 | $55.87 |
| Connecticut | 1 | Connecticut | $69.63 | $53.21 | $71.43 | $57.15 |
| Delaware | 1 | Delaware | $65.70 | $50.08 | $67.35 | $53.71 |
| District of Columbia | 1 | DC + MD/VA suburbs | $73.61 | $56.41 | $75.58 | $60.69 |
| Florida | 3 | Fort Lauderdale | $68.42 | $52.11 | $70.11 | $55.83 |
| Georgia | 2 | Rest of Georgia | $63.30 | $48.01 | $64.79 | $51.33 |
| Hawaii | 1 | Hawaii, Guam | $69.31 | $53.21 | $71.21 | $57.34 |
| Idaho | 1 | Idaho | $62.47 | $47.52 | $64.01 | $50.93 |
| Illinois | 4 | East St. Louis | $66.07 | $50.10 | $67.61 | $53.50 |
| Indiana | 1 | Indiana | $62.71 | $47.72 | $64.26 | $51.15 |
| Iowa | 1 | Iowa | $62.14 | $47.27 | $63.67 | $50.66 |
| Kansas | 1 | Kansas | $62.06 | $47.17 | $63.57 | $50.52 |
| Kentucky | 1 | Kentucky | $62.56 | $47.48 | $64.05 | $50.78 |
| Louisiana | 2 | Rest of Louisiana | $62.54 | $47.45 | $64.02 | $50.74 |
| Maine | 2 | Rest of Maine | $62.82 | $47.77 | $64.35 | $51.18 |
| Maryland | 2 | Rest of Maryland | $66.64 | $50.84 | $68.33 | $54.55 |
| Massachusetts | 2 | Rest of Massachusetts | $67.80 | $51.82 | $69.56 | $55.67 |
| Michigan | 2 | Rest of Michigan | $63.79 | $48.44 | $65.32 | $51.83 |
| Minnesota | 1 | Minnesota | $65.37 | $50.00 | $67.09 | $53.77 |
| Mississippi | 1 | Mississippi | $61.30 | $46.47 | $62.74 | $49.68 |
| Missouri | 3 | Metropolitan Kansas City | $64.23 | $48.85 | $65.79 | $52.32 |
| Montana | 1 | Montana | $66.13 | $50.43 | $67.80 | $54.11 |
| Nebraska | 1 | Nebraska | $62.34 | $47.44 | $63.88 | $50.86 |
| Nevada | 1 | Nevada | $65.77 | $50.18 | $67.45 | $53.86 |
| New Hampshire | 1 | New Hampshire | $67.09 | $51.27 | $68.83 | $55.08 |
| New Jersey | 2 | Rest of New Jersey | $70.49 | $53.87 | $72.32 | $57.86 |
| New Mexico | 1 | New Mexico | $64.08 | $48.66 | $65.61 | $52.06 |
| New York | 5 | Manhattan | $74.57 | $57.02 | $76.51 | $61.26 |
| North Carolina | 1 | North Carolina | $63.25 | $48.13 | $64.81 | $51.58 |
| North Dakota | 1 | North Dakota | $64.74 | $49.44 | $66.42 | $53.12 |
| Ohio | 1 | Ohio | $63.51 | $48.24 | $65.03 | $51.62 |
| Oklahoma | 1 | Oklahoma | $62.36 | $47.35 | $63.85 | $50.66 |
| Oregon | 2 | Rest of Oregon | $65.32 | $49.84 | $66.98 | $53.50 |
| Pennsylvania | 2 | Rest of Pennsylvania | $63.51 | $48.26 | $65.05 | $51.66 |
| Puerto Rico | 1 | Puerto Rico | $66.43 | $50.69 | $68.12 | $54.40 |
| Rhode Island | 1 | Rhode Island | $67.52 | $51.54 | $69.24 | $55.33 |
| South Carolina | 1 | South Carolina | $63.47 | $48.26 | $65.02 | $51.68 |
| South Dakota | 1 | South Dakota | $64.58 | $49.33 | $66.25 | $53.00 |
| Tennessee | 1 | Tennessee | $62.29 | $47.35 | $63.80 | $50.72 |
| Texas | 8 | Fort Worth | $65.71 | $50.07 | $67.35 | $53.71 |
| Utah | 1 | Utah | $64.07 | $48.74 | $65.64 | $52.22 |
| Vermont | 1 | Vermont | $64.67 | $49.36 | $66.33 | $53.00 |
| Virgin Islands | 1 | Virgin Islands | $66.43 | $50.69 | $68.12 | $54.40 |
| Virginia | 1 | Virginia | $64.93 | $49.51 | $66.57 | $53.13 |
| Washington | 2 | Rest of Washington | $67.62 | $51.69 | $69.38 | $55.54 |
| West Virginia | 1 | West Virginia | $63.16 | $47.83 | $64.61 | $51.07 |
| Wisconsin | 1 | Wisconsin | $63.24 | $48.21 | $64.84 | $51.75 |
| Wyoming | 1 | Wyoming | $65.53 | $50.00 | $67.20 | $53.68 |
How Medicare sets your locality rate
The formula
Each code has three relative value units (RVUs): work, practice expense and malpractice. Each is multiplied by your locality’s geographic practice cost index (GPCI), the three are added, and the sum is multiplied by the conversion factor: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × $33.4009.
Worked example: Miami, Florida
Companian is headquartered in Miami, so here is its locality. Miami (locality 04, Miami-Dade and Monroe counties) has 2026 GPCIs of 1.000, 1.041 and 2.529. For 99490: (1.00 × 1.000 + 0.91 × 1.041 + 0.07 × 2.529) × $33.4009 = $70.95, about 7% above the national $66.13. A practice billing 150 patient-months of 99490 there would see about $10,643 a month in allowed amounts, against $9,920 at the national rate.
How the locality is set
The locality follows the practice location on the claim, not the patient’s home. A practice with offices in two localities is paid each locality’s amount for claims from that office. Most states are a single statewide locality; California has 29, Texas 8 and New York 5.
Groups paid on different terms
- Rural health clinics and FQHCs: paid each care management code’s national non-facility amount, whatever the county. See care management for FQHCs and rural health clinics.
- Qualifying APM participants: a 2026 conversion factor of $33.5675 instead of $33.4009, about 0.5% more. 99490 comes to about $66.46 nationally. See care management for ACOs.
- Non-participating providers: 95% of the participating amount.
- Medicare Advantage: plans pay under their own contracts. Everything on this page is Original Medicare.
What one patient-month pays, by minutes
Care management pays in steps. One patient-month at each step, in 2026 national Medicare-allowed amounts, which include the patient’s share:
| Care team time in the month | Codes billed | National 2026 |
|---|---|---|
| Under 20 minutes | Nothing billable for CCM | $0.00 |
| 20 to 39 minutes | 99490 | $66.13 |
| 40 to 59 minutes | 99490 + 99439 | $116.57 |
| 60 minutes or more | 99490 + 99439 × 2 | $167.01 |
| 60 minutes, complex care plan | 99487 | $144.29 |
| 90 minutes, complex care plan | 99487 + 99489 | $222.45 |
| 30 to 59 minutes, one serious condition | 99426 | $67.80 |
| 60 to 89 minutes, one serious condition | 99426 + 99427 | $121.91 |
A second 20 minutes adds $50.44 through 99439. Cost-sharing climbs with the codes: a 40-minute CCM month carries about $23.31 of patient share at national rates.
Panel-size scenarios for chronic care management reimbursement
Illustrations, not projections: 2026 national Medicare-allowed amounts for Original Medicare patients, before staffing costs and unpaid patient share.
Every patient reaches 20 minutes
| Billable patients each month | Per month | Per year |
|---|---|---|
| 50 | $3,306.50 | $39,678.00 |
| 100 | $6,613.00 | $79,356.00 |
| 200 | $13,226.00 | $158,712.00 |
A mixed panel of 150 enrolled patients
Enrolled is not the same as billable. In this illustrative month, 100 patients reach 20 minutes, 30 reach 40 minutes and 20 fall short.
| Patients | Codes | National 2026 |
|---|---|---|
| 100 | 99490 | $6,613.00 |
| 30 | 99490 + 99439 | $3,497.10 |
| 20 | Under 20 minutes | $0.00 |
| 150 | Month total | $10,110.10 |
| 150 | Year total, 12 such months | $121,321.20 |
The 20 short months cost about $1,323 at the national rate, close to the $1,513 that 99439 adds for the 30 longer months. Keeping patients above 20 minutes matters as much as adding minutes.
How firm each number is
Every amount here is computed from the CMS CY 2026 RVU26D files (RVUs and GPCIs) at the $33.4009 non-QP conversion factor. Your Medicare Administrative Contractor’s fee schedule lookup is the official amount for your locality; check it before you budget.
Questions about CCM payment
Which states pay the most for chronic care management?
Alaska pays the most for 99490 in 2026 ($83.76), followed by high-cost California localities around San Jose and San Francisco. Arkansas pays the least ($60.71). Most states sit within a few dollars of the national $66.13.
What changed for care management payment in 2026?
The non-QP conversion factor rose 3.26%, from $32.3465 to $33.4009. Care management codes were exempt from the 2.5% efficiency adjustment to work RVUs of non-time-based services. CCM rules did not change structurally. Our summary of the 2027 physician fee schedule proposed rule covers what CMS has proposed next.
Is G0511 still paid in 2026?
No. RHCs and FQHCs stopped billing G0511 when the grace period ended on September 30, 2025. They now bill the individual codes.
Why is the facility amount lower?
The facility amount uses a lower practice expense value, because the facility carries those costs. For 99490 it is $43.76 nationally versus $66.13 non-facility. This page reports non-facility amounts, which apply to services billed from a practice setting.
How is Companian paid?
Your practice bills Medicare under its own license and receives the payment. Companian’s fee is set in the services agreement and walked through on the intro call; see chronic care management services.
Does PIN or CHI change the 99490 amount?
No. Each code is paid on its own. PIN and CHI can be billed in the same month as CCM if no time is counted twice; see PIN codes G0023 and G0024.