CPT 99490: Chronic Care Management, First 20 Minutes
CPT 99490 reports the first 20 minutes of clinical staff time, directed by a physician or QHP, delivering non-complex chronic care management (CCM) per calendar month to a patient with two or more chronic conditions. In 2026 Medicare pays about $66.13 non-facility (1.98 total RVUs times the $33.4009 conversion factor).
- Code type
- Chronic care management (staff, base)
- 2026 non-facility
- $66.13 (1.98 RVUs)
- 2026 facility
- $43.76 (1.31 RVUs)
- Requirement
- 20 min staff time / calendar month
What is CPT 99490 used for?
CPT 99490 is the base chronic care management (CCM) code. It reports the first 20 minutes of clinical staff time per calendar month, directed by a physician or QHP, coordinating care for a patient with two or more chronic conditions expected to last at least 12 months. CCM captures the between-visit work, care planning, medication reconciliation, and coordination, that keeps complex patients out of the ED.
To bill it, the qualifying conditions must place the patient at significant risk of decompensation, and the program must include documented patient consent, a comprehensive electronic care plan, and 24/7 access to care. The 20 minutes is a floor, not a target: fall short and there is nothing to bill for that month, so the monthly time log is the load-bearing piece of the record.
How much does 99490 pay in 2026?
99490 carries 1.98 non-facility RVUs and 1.31 facility RVUs. At the 2026 conversion factor of $33.4009 that is about $66.13 non-facility and $43.76 in a facility, every month per eligible patient. Because it recurs monthly across a whole panel, CCM becomes meaningful revenue at scale even though any single claim is modest. When staff time runs past 20 minutes, each additional full 20 minutes stacks on with 99439. Model your panel revenue with the Medicare fee calculator.
What does the CCM family look like?
Non-complex CCM stacks by time and complexity:
| Code | Service | 2026 non-facility |
|---|---|---|
| 99490 | First 20 min staff time | ~$66.13 |
| 99439 | Each additional 20 min staff time | ~$50.44 |
| 99491 | First 30 min physician/QHP time | ~$89.18 |
| 99487 | Complex CCM, first 60 min | ~$144.29 |
Frequently asked questions
The patient must have two or more chronic conditions expected to last at least 12 months (or until death) that place them at significant risk. You need patient consent, a comprehensive electronic care plan, 24/7 access to care, and at least 20 minutes of clinical staff time per calendar month directed by a physician or QHP. Document the time and activities.
The 2026 national non-facility allowed amount is about $66.13 (1.98 total RVUs times $33.4009) and about $43.76 in a facility. Because it is billed monthly per eligible patient, CCM becomes meaningful recurring revenue at panel scale.
99490 covers the first 20 minutes of clinical staff time directed by the physician. 99491 covers 30 minutes of CCM provided personally by the physician or QHP. Use 99491 when the practitioner personally delivers the care management time; use 99490 when clinical staff do the work under direction. You cannot count the same minutes twice.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
Stop losing revenue to problems like this.
A free billing audit shows exactly where your practice is leaking money — no cost, no commitment.
