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CPT code 99490 is the foundational Medicare Part B procedure code used to bill non-complex Chronic Care Management (CCM) services furnished by clinical staff under the general supervision of a physician or other Qualified Healthcare Professional (QHP). Under Centers for Medicare & Medicaid Services (CMS) rules, CPT 99490 reimburses at least 20 minutes of non-face-to-face clinical staff time per calendar month dedicated to establishing, implementing, revising, or monitoring a comprehensive electronic care plan for a patient with two or more chronic conditions expected to last at least 12 months (or until the death of the patient) that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
What Is CPT Code 99490? Complete CCM CPT Code Family Matrix (99490, 99439, 99491, 99437, 99487, 99489)
When designing Chronic Care Management (CCM) programs, revenue cycle and clinical operations teams must distinguish among three mutually exclusive monthly billing pathways defined in the AMA CPT manual and the CMS Medicare Learning Network (MLN) CCM booklet (MLN909188): (1) Non-Complex Clinical Staff CCM (99490 + 99439), (2) Non-Complex Physician/QHP Personal CCM (99491 + 99437), and (3) Complex Clinical Staff CCM (99487 + 99489).
| CPT / HCPCS Code | CCM Pathway & Code Type | Who Performs the Logged Time? | Monthly Time Threshold & Unit Cap | Medical Decision Making (MDM) & Care Plan Rule |
|---|---|---|---|---|
CPT 99490 |
Non-Complex CCM (Base Code) | Clinical staff (RN, LPN, MA, pharmacist, care coordinator) under general supervision of billing practitioner. | First 20 minutes per calendar month (1 unit max/month). | Comprehensive care plan established, implemented, revised, or monitored; no complex MDM threshold. |
CPT 99439 |
Non-Complex CCM (Add-On to 99490) |
Clinical staff under general supervision. | Each additional 20 minutes per calendar month (max 2 units/month: 40–59 min = 1 unit; ≥60 min = 2 units). |
Billed only alongside primary code 99490 when non-complex staff time reaches 40+ or 60+ minutes. |
CPT 99491 |
Non-Complex Practitioner CCM (Base Code) | Personally performed by the billing Physician or QHP (NP, PA, CNS, CNM); clinical staff time cannot be counted. | First 30 minutes of personal physician/QHP time per calendar month (1 unit max/month). | Comprehensive care plan established, implemented, revised, or monitored personally by the practitioner. |
CPT 99437 |
Non-Complex Practitioner CCM (Add-On to 99491) |
Personally performed by the billing Physician or QHP. | Each additional 30 minutes of personal physician/QHP time per calendar month (max 2 units/month under CMS MUE). | Billed only alongside primary code 99491 (e.g., 60+ min = 99491 + 99437). |
CPT 99487 |
Complex CCM (Base Code) | Clinical staff directed by a physician or QHP. | First 60 minutes of clinical staff time per calendar month (1 unit max/month). | Requires establishment or substantial revision of a comprehensive care plan AND moderate-to-high complexity Medical Decision Making (MDM) by the practitioner during the month. |
CPT 99489 |
Complex CCM (Add-On to 99487) |
Clinical staff directed by a physician or QHP. | Each additional 30 minutes of clinical staff time beyond the initial 60 minutes (e.g., ≥90 min = 99487 + 99489). |
Billed only alongside primary code 99487. |
HCPCS G0511 |
FQHC / RHC General Care Management | Clinical staff or practitioner in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). | At least 20 minutes of CCM, PCM, BHI, or RPM services per calendar month. | Composite care management code used by FQHCs and RHCs instead of standalone 99490 claims. |
Crucial Time-Threshold Decision Tree for Clinical Staff CCM: Because CPT 99439 and CPT 99487 overlap at the 60-minute mark, coders must check whether the billing practitioner performed moderate-to-high complexity MDM (compare 99214 vs. 99215 MDM rules) and substantially revised the care plan during that calendar month:
- 20–39 minutes of clinical staff time: Bill
99490 x 1. - 40–59 minutes of clinical staff time: Bill
99490 x 1+99439 x 1. - ≥60 minutes of clinical staff time (routine monitoring, NO moderate/high MDM or substantial care plan revision): Bill
99490 x 1+99439 x 2. - 60–89 minutes of clinical staff time (WITH moderate/high MDM and substantial care plan revision): Bill
99487 x 1(do not bill99490or99439in the same month). - ≥90 minutes of clinical staff time (WITH moderate/high MDM): Bill
99487 x 1+99489 x 1(plus additional units of99489for each full 30-minute increment).
CMS Pre-Claim Compliance Checklist for CPT 99490
Before submitting a Medicare Part B claim for CPT 99490, the billing practice must verify and document all six statutory and regulatory prerequisites in the certified EHR:
- Eligible Billing Practitioner: Only one practitioner may furnish and bill CCM for a given beneficiary in a calendar month—specifically a Physician (MD/DO), Nurse Practitioner (NP), Physician Assistant (PA), Clinical Nurse Specialist (CNS), or Certified Nurse-Midwife (CNM). Under CMS incident-to exceptions (`42 CFR § 410.26(b)(5)`), clinical staff time for
99490,99439,99487, and99489may be furnished under general supervision (the supervising practitioner does not have to be physically present in the same office suite while the nurse or care coordinator performs the outreach call, provided the clinical staff are auxiliary personnel of the billing practice). - Initiating Visit for New Patients (or Patients Unseen in 12 Months): For any patient who is new to the billing practitioner or has not been seen within the preceding 12 months, the practitioner must first conduct a face-to-face (or qualifying telehealth) initiating visit—such as an Evaluation & Management (E/M) office visit (E/M coding in chronic care), an Annual Wellness Visit (AWV,
G0438/G0439), or an Initial Preventive Physical Examination (IPPE,G0402)—and discuss CCM during that visit. Time spent in the initiating visit cannot be counted toward the 20-minute monthly99490threshold. - Advance Verbal or Written Patient Consent (4 Mandatory Disclosures): Prior to furnishing or billing CCM, the practice must obtain and document in the EHR the patient’s informed consent (either written or verbal) confirming that the patient was informed of:
- The availability of CCM services and applicable 20% Medicare Part B coinsurance and deductible cost-sharing (CCM is not exempt from coinsurance like an AWV, though Medigap or Medicaid crossover often covers it);
- That only one practitioner can furnish and be paid for CCM services during a calendar month;
- Permission for electronic communication of the patient’s medical information with other treating providers for care coordination; and
- The patient’s right to stop or revoke CCM services at any time (effective at the end of the current calendar month).
- Comprehensive Electronic Care Plan (Shared with Patient): The practice must establish and maintain a person-centered electronic care plan in a CMS-certified EHR covering: (a) a problem list of all chronic conditions, (b) expected outcome and prognosis, (c) measurable treatment goals, (d) cognitive and functional assessment, (e) symptom management, (f) planned interventions, (g) comprehensive medication reconciliation and adherence review, and (h) community/social services ordered. A copy of the care plan must be given to the patient/caregiver and made electronically available on a 24/7 basis to all care team members within the practice.
- 24/7 Access to Clinicians & Continuity of Care: Patients enrolled in CCM must have 24-hour-a-day, 7-day-a-week access to physicians, QHPs, or clinical staff to address urgent chronic care needs, along with continuity of care with a designated care team member with whom the patient can schedule successive appointments.
- Granular, Non-Overlapping Time Logs: Each logged CCM activity entry in the EHR must record the date, exact duration in minutes, performing clinical staff member’s name and credentials, and a brief clinical description of the non-face-to-face work performed (e.g., “12 min: Telephone outreach to patient reviewing cardiology consult note, reconciling furosemide dose adjustment, and updating CHF care plan goals”).
Concurrent Billing Rules & HHS OIG Audit Traps
In multiple audits of Medicare Chronic Care Management claims, the HHS Office of Inspector General (OIG) identified improper payments resulting from prohibited code combinations and double-counted clinical staff minutes. Compliance teams should enforce the following edits in their billing scrubber:
| Service / Code Category | Can It Be Billed in the Same Calendar Month as CPT 99490? |
CMS & OIG Compliance Rule |
|---|---|---|
| Remote Physiologic Monitoring (RPM: CPT 99457 / 99458) | YES (Allowed) | CMS explicitly permits billing both CCM (99490) and RPM treatment management (99457/99458) in the same calendar month for the same patient, provided time is never double-counted (i.e., at least 20 distinct minutes for RPM + at least 20 distinct minutes for CCM = 40+ total minutes). |
Complex CCM (99487 / 99489) or Personal CCM (99491 / 99437) |
NO (Mutually Exclusive) | A practice cannot bill 99490 in the same calendar month as 99487 or 99491. However, if a physician personally spends 10 minutes and clinical staff spend 15 minutes (total 25 min), the physician’s time can be added to the clinical staff pool to bill 99490. |
Principal Care Management (PCM: 99424–99427) |
NO (By Same Practitioner) | PCM (which targets 1 high-risk condition) and CCM (which targets ≥2 chronic conditions) cannot be billed concurrently by the same practitioner for the same patient in the same month. |
Home Health / Hospice Care Plan Oversight (G0181, G0182) & ESRD Monthly Capitation (90951–90970) |
NO (Prohibited Overlap) | CPT 99490 cannot be billed during any calendar month in which the practitioner bills Home Health Care Plan Oversight (G0181), Hospice Care Plan Oversight (G0182), or monthly End-Stage Renal Disease (ESRD) capitation codes. |
Transitional Care Management (TCM: 99495, 99496) |
Conditional (Only Outside 30-Day TCM Service Period or With Exceptional Documentation) | Time spent fulfilling the 30-day post-discharge TCM service period cannot be counted toward 99490; CCM may only be billed in the same calendar month if the 30-day TCM window ends prior to the end of the month and at least 20 separate minutes of CCM are furnished after the TCM period closes. |
Frequently Asked Questions
What is CPT code 99490?
CPT code 99490 is a Medicare Part B procedure code for non-complex Chronic Care Management (CCM) services covering at least 20 minutes of clinical staff time per calendar month directed by a physician or Qualified Healthcare Professional (QHP). It applies to patients with two or more chronic conditions expected to last at least 12 months (or until death) that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, and requires advance patient consent and a comprehensive electronic care plan.
How is CPT code 99490 used in clinical research and healthcare?
In primary care, specialty ambulatory clinics, and pragmatic health-services research, CPT 99490 (alongside add-on code 99439, practitioner code 99491, and complex CCM codes 99487/99489) funds structured longitudinal nurse care coordination, medication reconciliation, post-discharge follow-up, and chronic disease self-management support—often paired with Remote Physiologic Monitoring (CPT 99453–99458) to reduce preventable emergency department visits and hospital readmissions.
