CPT 99490: Chronic Care Management, First 20 Minutes
99490 reports the first 20 minutes of chronic care management by clinical staff in a calendar month, for a patient with two or more chronic conditions and a care plan. It is billed once a month once consent, an initiating visit and the time log are in the chart.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99490 is a monthly code based on 20 minutes of clinical staff time. Before billing, you need consent, a care plan and, for a new patient, an initiating visit. Only one practitioner can bill CCM for a patient in a month.
What Does CPT 99490 Report?
99490 is non-complex chronic care management (CCM): the first 20 minutes of clinical staff time in a calendar month, directed by a physician or other qualified practitioner. The patient has two or more chronic conditions expected to last at least 12 months, or until death, that put the patient at significant risk, and a comprehensive care plan is in place. The CMS fee schedule file labels it "Chrnc care mgmt staff 1st 20".
| Item | Value in the file |
|---|---|
| Payment status | A (active code) |
| Work RVU | 1.00 |
| Non-facility total RVU | 1.98 |
| Facility total RVU | 1.31 |
| Global period | XXX |
| MUE | 1 per date of service, adjudication indicator 2 (policy) |
Which CCM Code Fits the Time and the Staff?
MLN909188 sorts the CCM codes by who does the work and how long it takes in the month.
| Code | Care type | Who counts | Time |
|---|---|---|---|
| 99490 | Chronic care management | Clinical staff | First 20 minutes |
| 99439 (add-on) | Chronic care management | Clinical staff | Each additional 20 minutes |
| 99491 | Chronic care management | Physician or other qualified professional | First 30 minutes |
| 99437 (add-on) | Chronic care management | Physician or other qualified professional | Each additional 30 minutes |
| 99487 | Complex chronic care management | Clinical staff | First 60 minutes |
| 99489 (add-on) | Complex chronic care management | Clinical staff | Each additional 30 minutes |
For 99490 and 99439, time spent personally by the billing practitioner counts too, as long as it is not used to report 99491. For 99491 and 99437, only the practitioner's own time counts, and clinical staff time does not.
What Must Be in Place Before You Bill 99490?
- An initiating visit for new patients or patients not seen within the previous year. It must be a comprehensive face-to-face E/M visit, an annual wellness visit or an initial preventive exam, and CCM must be discussed there.
- Patient consent, written or verbal, documented in the record. The patient must hear that cost sharing may apply, that only one practitioner can bill CCM in a month, and that the patient can stop at the end of any calendar month.
- An electronic comprehensive care plan, shared promptly inside and outside the practice.
- 24 hour, 7 day access for urgent needs, and a designated care team member for routine contact.
- Structured recording of demographics, problems, medications and allergies in a certified EHR.
Consent is needed only once unless the patient switches to a different CCM practitioner. MLN909188 adds that limited-license practitioners such as clinical psychologists, podiatrists and dentists cannot bill CCM, though they can take part in the patient's care.
What Can and Cannot Be Billed in the Same Month?
- Non-complex and complex CCM cannot be billed for one patient in one month, so 99490 and 99487 do not share a month.
- CCM cannot be billed in the same service period as home health supervision (G0181), hospice supervision (G0182) or the ESRD monthly codes 90951 to 90970.
- CCM can be billed during the 30 day transitional care management period.
- Time counted toward CCM cannot also count toward another billed code.
- Remote physiologic or therapeutic monitoring, but not both, may run alongside CCM. See remote monitoring 99457 and the CCM and RPM billing service for the combined rules.
Advanced primary care management (HCPCS G0556 to G0558) bundles care management into one monthly code with no minute counting. It is an alternative payment path, and the CCM booklet describes it separately.
How Does 99490 Appear on the Claim?
On the CMS-1500, Item 24D carries 99490 and Item 24G carries 1 unit, matching the MUE of 1. Item 24E points to the chronic condition diagnoses that qualify the patient.
99490 is not on the CMS list of telehealth services for 2026. The CCM booklet describes the service as non-face-to-face, so there is no telehealth place of service or modifier to report. Groups that bill it often include internal medicine, family medicine and home health.
Which Claim Fields Does 99490 Use?
Chronic care management is a monthly service, so the date in Item 24A and the units in Item 24G matter more than most. One line, 1 unit, and a service date that falls in the month the 20 minutes were reached is the usual shape. Item 24E points to one of the qualifying chronic conditions listed in Item 21.
RVU26D lists 99490 with status A and global XXX. The MUE of 1 has indicator 2, a policy edit, so the second unit in a month cannot be billed by adding units.
Example: In October a practice logs 24 minutes of staff care management for a patient with diabetes and heart failure. The claim shows 99490, pointer A (E11.9), 1 unit, dated at month end. If a second practice also billed CCM that month, the later claim would draw CO-151.
Why Is 99490 Denied?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CO-151 | Information does not support this many or this frequency of services | A second practitioner billed CCM for the same patient and month |
| CO-97 | The benefit is included in the payment for another service already adjudicated | Billed in the same month as a code the payer treats as overlapping |
| CO-50 | Not deemed a medical necessity by the payer | Fewer than two qualifying chronic conditions on the claim |
| CO-16 | Claim lacks information or has a billing error | No diagnosis pointer, or no initiating visit on file |
If these denials keep coming back, our denial management team can work them. The visit that often starts CCM is 99214.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
- Chronic Care Management Services (MLN909188, June 2025) · CMS
- List of Telehealth Services for Calendar Year 2026 · CMS
- HCPCS Level II quarterly update, October 2026 alpha-numeric file · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What is required to bill CCM 99490 each month?
The patient needs two or more chronic conditions and a comprehensive care plan, and clinical staff time under your direction must reach 20 minutes in the calendar month. You also need an initiating visit when the patient is new or unseen for a year, plus documented consent.
02How is care coordination time counted toward CCM minutes?
For 99490 and 99439, time by clinical staff counts, and so does time by the billing practitioner if it is not used for 99491. Time counted toward CCM cannot also count toward another billed code. Keep a month log with who spent each block.
03Who can bill 99490?
Physicians, certified nurse-midwives, clinical nurse specialists, nurse practitioners and physician assistants can bill CCM, per MLN909188. Clinical staff can do the work under general supervision as incident-to services. Limited-license practitioners such as clinical psychologists, podiatrists and dentists cannot bill it.
04Does the patient pay anything for CCM?
Yes. MLN909188 says patient cost sharing applies to CCM, and some patients have supplemental insurance that helps cover it. The patient must be told about possible cost sharing before you bill, and the consent conversation and the patient's answer should be documented in the record before the first claim.
05What is the difference between 99490 and 99491?
99490 counts clinical staff time, starting at 20 minutes, while 99491 counts only the billing practitioner's own time, starting at 30 minutes. 99439 and 99437 are the matching add-ons for further time, in 20 minute and 30 minute steps. Complex CCM is separate: 99487 starts at 60 minutes.
06Can 99490 be billed during the transitional care management period?
Yes. MLN909188 says CCM codes can be reported for services during the 30 day TCM period, codes 99495 and 99496, as long as the time is not counted twice. Home health and hospice supervision codes are different, because they block CCM in the same period.
CCM Minutes Not Turning into Paid Claims?
We check consent, the initiating visit and the monthly time log before the claim goes out.