Chronic Care Management (CCM) helps healthcare providers support patients living with multiple chronic conditions between visits. CPT 99490 is the foundational code that enables reimbursement for the time clinical staff spend coordinating care each month under the supervision of a qualified healthcare professional. When billed correctly, it supports continuity, compliance, and better patient outcomes.
If interested in learning more about the CCM Program, read our article Chronic Care Management: The Blueprint for Continuous, Collaborative Patient Care.
CPT 99490 Fundamentals
CPT 99490 covers at least 20 minutes of non-face-to-face care coordination provided by clinical staff per calendar month. These services are performed under the general supervision of a physician or other qualified healthcare professional.
Eligible patients have two or more chronic conditions expected to last at least 12 months, or until the patient’s death, and that pose significant risk of death, acute exacerbation, or functional decline.
This code acknowledges the vital behind-the-scenes work that keeps patients stable and connected to care.
Typical qualifying activities include:
- Medication management and reconciliation
- Coordination with specialists and community resources
- Reviewing lab or test results
- Scheduling follow-ups and tracking adherence
- Updating goals and care plans based on patient progress
Each activity must be documented with a date, time, and description that clearly contributes to the monthly total of 20 minutes or more.
How to Bill CPT 99490 and Meet CCM Requirements
Correct billing for CPT 99490 depends on consistent documentation and a clearly defined workflow.
Patient consent and enrollment
Before services begin, the provider must obtain verbal or written consent and record it in the patient’s chart. Patients should understand that only one practitioner may bill CPT 99490 for them in any given month.
Comprehensive care plan
Every CCM patient must have an individualized care plan that is problem-based, electronically shareable, and regularly reviewed. The plan should outline health problems, goals, interventions, and responsible care team members.
Monthly time tracking
All qualifying activities need to be captured accurately. Practices may use automated CCM software for CPT 99490 or manual logs. If the total clinical time exceeds 20 minutes, additional minutes can be billed using CPT 99439 for each extra 20-minute increment.
Supervision and compliance
Clinical staff perform services under general supervision, meaning the supervising professional does not need to be physically present but remains responsible for oversight and documentation standards.
Avoiding common audit pitfalls
Common reasons for claim denials include:
- Missing or incomplete consent documentation
- Care plans not accessible in the electronic record
- Insufficient time tracking or over-counted minutes
- Duplicate billing with overlapping time-based services
- Establishing standardized templates and monthly internal reviews helps maintain compliance
Inside a 99490 Claim
Medicare reimbursement for CPT 99490 varies by region, with a current national average of approximately $60.49. Providers should confirm exact rates using the CMS Physician Fee Schedule Look-Up Tool.
Example workflow:
Patient: 72-year-old with diabetes and hypertension
Activities this month:
- Reviewed blood glucose readings
- Reconciled medications with pharmacy
- Updated care plan and called patient to discuss changes
- Coordination with endocrinologist
Total time: 28 minutes
Billed: CPT 99490 (base code)
*If another 20 minutes of staff time were documented, CPT 99439 could be added for the extended service.
Vivo Care Best Practices for CPT 99490 Billing
Consistency and communication are key to a successful Chronic Care Management program. These best practices help ensure efficiency and compliance.
Automate tracking and documentation
Use a CCM platform that automatically timestamps and categorizes care activities. This reduces manual entry errors and captures every qualifying minute.
Train and empower your care team
All team members should know which tasks qualify for billing and how to record them. Regular refresher training keeps documentation practices aligned with CCM CPT 99490 guidelines.
Integrate CCM into everyday workflows
Incorporate chronic care tasks naturally into clinical operations. For instance, review medication adherence during regular follow-up calls or lab result discussions, and update the care plan on the spot.
Schedule compliance reviews
CMS occasionally updates billing and supervision guidance. Setting quarterly audits helps confirm that your forms, templates, and logs remain current with 99490 billing requirements.
Common Billing Challenges and Solutions
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| Incomplete time documentation | Use electronic tools that capture and sum all staff activities. |
| Unclear supervision roles | Review CMS rules on general supervision and delegate tasks appropriately. |
| Low patient engagement | Explain the value of CCM at onboarding and maintain regular outreach. |
| Rejected or delayed claims | Verify payer rules, check for overlapping codes, and confirm documentation completeness. |
Frequently Asked Questions
What is CPT 99490 used for?
It reimburses for at least 20 minutes per month of coordinated care for patients with two or more chronic conditions.
How do I bill CPT 99490 under Medicare?
Obtain patient consent, establish a care plan, track all qualifying time, and submit a single monthly claim.
What are the key Chronic Care Management 99490 requirements?
Two or more chronic conditions, 20 minutes of documented clinical staff time, a comprehensive care plan, and services under general supervision.
How does G0506 differ from 99490?
G0506 covers the provider’s face-to-face evaluation when initiating CCM, while 99490 reimburses for ongoing care coordination.
Who can provide CCM billing services?
Clinical staff such as nurses or medical assistants, working under the general supervision of a physician or qualified healthcare professional.
From Billing Code to Better Outcomes
When used correctly, CPT 99490 provides a framework for proactive, patient-centered care and ensures fair Medicare reimbursement for essential coordination work. It rewards practices that stay engaged with their chronic-care patients throughout the month, reducing hospitalizations and improving quality of life.
Vivo Care helps practices implement these workflows with automated time tracking, integrated documentation, and tools that keep patients connected and clinicians compliant. By aligning care coordination with clear processes, providers can turn routine follow-ups into measurable results for both patients and the practice. Click here for a free consultation.