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Medicare care management billing guides
68 guides to CCM, PCM, APCM, PIN, CHI, TCM and RPM billing for physician practices, updated for 2026.
Care management billing codes
Every code we staff, with 2026 rates, time rules and documentation.
CCM CPT codes: the complete 2026 code set
Chronic care management CPT codes for 2026: 99490, 99439, 99487, 99489, 99491 and 99437, their time rules, combinations and 2026 payment.
Read the guide →CPT 99490: the first 20 minutes of CCM, explained
CPT 99490 explained: the first 20 minutes of chronic care management, what counts, how to document it and 2026 payment by locality.
Read the guide →CPT 99439: each additional 20 minutes of CCM
CPT 99439 explained: each additional 20 minutes of chronic care management, units per month, documentation and 2026 payment.
Read the guide →CPT 99487 and 99489: complex CCM, explained
CPT 99487 and 99489 explained: complex CCM requirements, the 60- and 30-minute time rules, code conflicts and 2026 Medicare payment.
Read the guide →CPT 99491 and 99437: physician-led CCM billing
99491 CPT code description, the 99437 add-on, how both differ from 99490, same-month rules and 2026 Medicare payment.
Read the guide →Principal care management CPT codes: 99424 to 99427
Principal care management CPT codes 99424 to 99427: who spends the time, the 30-minute floor, 2026 rates, example months and documentation.
Read the guide →What is APCM? Advanced primary care management, explained
APCM codes G0556, G0557, G0558: how to pick the level, who bills, 2026 rates and add-ons, what cannot be billed alongside, and documentation.
Read the guide →APCM behavioral health add-on codes: G0568, G0569 and G0570
APCM behavioral health add-on codes G0568, G0569 and G0570: 2026 rules, required elements, no minute count, and 2026 payment.
Read the guide →G0023 and G0024: principal illness navigation codes
Principal illness navigation codes G0023 and G0024: who qualifies, the initiating visit, the 60-minute threshold, documentation and 2026 payment.
Read the guide →G0019 and G0022: community health integration codes
Community health integration codes G0019 and G0022: the upstream driver, initiating visit, CHW training, minute examples and 2026 rates.
Read the guide →G0511 is gone: how RHCs and FQHCs bill care management in 2026
G0511 ended September 30, 2025.
Read the guide →CPT 99495: moderate-complexity TCM billing guide
CPT 99495 billing guide for 2026: the moderate-complexity TCM descriptor, 14-day visit rule, RVUs, payment by locality and common claim errors.
Read the guide →CPT 99496: high-complexity TCM and how it differs from 99495
CPT 99496 explained: the high-complexity TCM code, its 7-day visit rule, 99495 vs 99496, 2026 payment and what happens if the visit slips.
Read the guide →CPT 99484: general behavioral health integration billing
CPT 99484 general behavioral health integration: required elements, who can bill, CCM and CoCM rules, and 2026 Medicare payment.
Read the guide →CPT 99492 to 99494: psychiatric collaborative care (CoCM)
CPT 99492, 99493, 99494 and G2214 explained: the collaborative care team, time thresholds, 2026 payment, and how CoCM differs from 99484 BHI.
Read the guide →CPT 99497 and 99498: advance care planning billing
CPT 99497 and 99498 advance care planning billing: descriptors, the 16-minute time rule, AWV cost-sharing waiver, 2026 payment and the 2027 proposal.
Read the guide →G2211 CPT code: the visit complexity add-on, explained
G2211 add-on code for 2026: eligible E/M base codes, the modifier 25 rule and exceptions, 2026 payment, care management use and the 2027 proposal.
Read the guide →Annual wellness visit CPT codes: G0438, G0439 and 2026 payment
Annual wellness visit CPT codes G0438 and G0439: eligibility, 12-month rules, 2026 payment, modifier 25 and ACP billing, and the AWV as a CCM starting point.
Read the guide →RPM CPT codes 2026: remote patient monitoring billing
Remote patient monitoring CPT codes for 2026: 99453, 99445, 99454, 99470, 99457 and 99458, RTM codes, CCM pairing rules and the 2027 proposals.
Read the guide →99454 CPT code description: RPM device supply and 99453 setup
The 99454 CPT code description is remote monitoring of physiologic parameters with device supply and daily recordings or programmed alert…
Read the guide →CPT 99457 and 99458: RPM treatment management time rules
CPT 99457 covers the first 20 minutes of remote physiologic monitoring (RPM) treatment management per calendar month; 99458 adds each further 20…
Read the guide →99483 CPT code description: cognitive assessment and care plan
The 99483 CPT code covers a detailed cognitive assessment and written care plan for a patient with any cognitive impairment, at any stage.
Read the guide →G0136 in 2026: from SDOH to physical activity and nutrition
Since January 1, 2026, G0136 covers a standardized, evidence-based physical activity and nutrition assessment lasting 5 to 15 minutes, once every 6…
Read the guide →G0506 CPT code description: the CCM initiating visit add-on
The G0506 CPT code description covers a one-time HCPCS add-on: extensive assessment and care planning the billing practitioner personally performs at…
Read the guide →Mental health CPT codes for primary care: BHI, CoCM and APCM
Common mental health CPT codes include 90791 and 90792 for diagnostic evaluations, 90832, 90834 and 90837 for psychotherapy, and 90833, 90836 and…
Read the guide →Remote therapeutic monitoring (RTM): codes, rules and RPM
Remote therapeutic monitoring (RTM) tracks non-physiological data on therapy adherence, treatment response and respiratory, musculoskeletal or…
Read the guide →CMS rules for care management
What CMS requires before, during and after a billed month.
Chronic care management requirements: the 2026 checklist
Chronic care management requirements from CMS: eligibility, initiating visit, consent, care plan, 24/7 access, time and exclusions, with what to…
Read the guide →What conditions qualify for chronic care management?
Chronic care management eligible conditions: the three-part CMS test, example conditions, the eligibility note and other programs to check.
Read the guide →Chronic care management consent: what Medicare requires
Chronic care management consent requirements: the four points CMS requires, verbal vs written, how to record consent, a sample script and rules by…
Read the guide →Chronic care management documentation: what to record monthly
Chronic care management documentation: enrollment records, time-log fields, CMS time-counting rules and a sample monthly CCM note.
Read the guide →CCM care plan template: what CMS expects in each plan
Chronic care management template: every CMS care plan element from MLN909188 as a field-by-field table, plus header fields and review triggers.
Read the guide →Care plan: what it is, what goes in it, and an example
A care plan records a patient’s conditions, goals, planned care and who is responsible.
Read the guide →General vs direct supervision: which Medicare services need which
General supervision vs direct supervision in Medicare: the three levels, virtual direct supervision in 2026, and why care management runs under…
Read the guide →Incident-to billing: Medicare rules for care management staff
Incident-to billing for care management: the 42 CFR 410.26 rules, general vs direct supervision, outside staff and the audit pitfalls to avoid.
Read the guide →QMB patients and care management: how to bill
QMB billing for care management: the CMS prohibition on billing QMBs cost-sharing, checking status, APCM level 3 (G0558) and Medicaid crossover.
Read the guide →Z codes for social determinants of health: a CHI guide
Social determinants of health Z codes (Z55 to Z65): categories, key subcodes, how they document upstream drivers for CHI, and the 2026 G0136 change.
Read the guide →SDOH screening: tools, questions and what Medicare pays in 2026
SDOH screening uses a standardized questionnaire to identify possible social needs, including housing, food, transportation, utilities and personal…
Read the guide →Social determinants of health: the 5 domains and what Medicare pays for
What are the five SDOH domains?
Read the guide →Community health workers and Medicare: billing CHI services
Community health worker billing under Medicare CHI: who bills G0019, what CHWs may do, training, contracting and state certification notes.
Read the guide →Medicare annual wellness visit checklist for providers
Medicare annual wellness visit checklist for 2026: every required G0438 and G0439 element, optional ACP, who can perform the AWV and what to document.
Read the guide →Choosing between programs and partners
Side-by-side guides for the decisions practices ask about most.
PCM vs CCM: which code family fits each patient
PCM vs CCM: eligibility, time thresholds, 2026 Medicare payment and same-month billing rules for principal and chronic care management, compared.
Read the guide →APCM vs CCM: rates, rules and how to choose
APCM vs CCM: who bills each, 2026 rates, a six-patient month, the 20-minute break-even and choosing patient by patient.
Read the guide →CCM vs RPM: how the two programs compare
Chronic care management vs remote patient monitoring: what each pays for, 2026 RPM codes 99445 and 99470, 2026 rates and billing both together.
Read the guide →Care management vs case management: the difference for practices
Care management vs case management: both involve assessment, care planning, referrals and follow-up.
Read the guide →Value-based care vs fee-for-service: what changes for a practice
Fee-for-service pays for each covered service billed.
Read the guide →Chronic care management in-house vs outsourced: a decision guide
Chronic care management in house or with a staffed partner?
Read the guide →How to choose a chronic care management company: 15 questions
How to compare chronic care management companies: 15 questions on billing, supervision, HIPAA, EHR documentation, staffing and contract terms.
Read the guide →Running care management day to day
How a month works, from enrollment to the billing file.
Chronic care management workflow: how to start a CCM program
Chronic care management workflow: eight steps from eligibility to claim, a week-by-week CCM month, team roles, escalation and month-end close.
Read the guide →Chronic care management call script for patient enrollment
A chronic care management call script with the four consent points, plus how to build the eligible list, record outcomes and hand out a CCM brochure.
Read the guide →CCM billing: a step-by-step guide for your billing team
Chronic care management billing at claim level: prerequisites, date of service, place of service, units, blocked code combinations and cost-sharing.
Read the guide →Chronic care management software: what it does and doesn’t
Chronic care management software explained: core features mapped to CMS rules, EHR integration, staffing math and an independent evaluation…
Read the guide →What does a care manager do? Role, skills and CCM time
What a chronic care manager does in a Medicare CCM program: monthly duties, skills, supervision and which staff time counts toward the CCM codes.
Read the guide →Chronic disease management: how practices run it between visits
Chronic disease management is planned, ongoing care for long-term conditions, including a care plan, medication review, coordination with other…
Read the guide →Gaps in care: what they are and how a care team closes them
Gaps in care are recommended services a patient is due but has not received, such as an overdue preventive service or no follow-up after a hospital…
Read the guide →Patient engagement in healthcare: what it looks like between visits
Patient engagement in healthcare means patients and families take an active part in decisions and care planning.
Read the guide →Patient-centered care: what it means and how practices deliver it
What does patient-centered care look like?
Read the guide →Medicare care management basics
Definitions, payment policy and 2026 rates by locality.
What is chronic care management? A plain-English guide
What is chronic care management?
Read the guide →What is a chronic condition? Definition, examples and Medicare’s rules
What counts as a chronic condition for Medicare?
Read the guide →Tertiary prevention: definition, examples and care management
Where does care management fit in prevention?
Read the guide →What is care management? A guide for physician practices
What is care management in Medicare?
Read the guide →What is care coordination? How it works in Medicare practices
What is care coordination?
Read the guide →Transitional care management (TCM): codes, rules and timing
Transitional care management in 2026: qualifying discharges, the 2-day contact and 7/14-day visit rules, 99495 vs 99496, billing and CCM overlap.
Read the guide →AWV medical abbreviation: what the annual wellness visit is
AWV stands for annual wellness visit: a Medicare Part B visit to complete a health risk assessment and develop or update a personalized prevention…
Read the guide →PCM medical abbreviation: what principal care management means
The PCM medical abbreviation has several meanings.
Read the guide →Chronic Care Model: the six elements and how practices apply them
The chronic care model is Edward Wagner’s framework for organizing primary care for chronic illness around six elements: the health system,…
Read the guide →Chronic care management reimbursement 2026, by locality
Chronic care management reimbursement 2026 by locality: 99490, 99439, 99426 and 99427 rates for every state, with the calculator and a worked example.
Read the guide →First Coast Medicare: fee lookups and Florida localities
First Coast Medicare explained for Florida practices: Jurisdiction N, the three payment localities, the fee schedule lookup, 2026 G-code fees and…
Read the guide →Medicare Physician Fee Schedule 2026: what changed for care management
What changed for care management in 2026?
Read the guide →2027 physician fee schedule: what changes for care management
The 2027 physician fee schedule proposed rule: conversion factors, the care management RFI, the RPM/RTM employed-staff proposal, G2211 and ACP codes.
Read the guide →Medicare ACO and the Shared Savings Program: a practice guide
Medicare Shared Savings Program primer for 2026: tracks, beneficiary assignment, the care management codes that count, and 2027 proposals.
Read the guide →Medicare GUIDE Program: the dementia care model explained
How does the GUIDE dementia model pay?
Read the guide →CMS ACCESS Model: eligibility, payments and practice billing
The CMS ACCESS Model is a voluntary payment test for technology-supported chronic care in Original Medicare, running from July 5, 2026 through June…
Read the guide →Hospital Readmissions Reduction Program: what practices should know
The Hospital Readmissions Reduction Program (HRRP) reduces Medicare payments to general acute care hospitals with excess 30-day unplanned…
Read the guide →Estimate your CCM revenue
Enter your Medicare patient count and locality to see 2026 CCM and PCM numbers.
Disclosures
These guides summarize CMS information for physician practices. They are not legal or billing advice.
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Read the guide →Questions about your own billing?
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