99490
Chronic care management, first 20 minutes
At least 20 minutes of clinical staff time directed by a physician or other qualified health professional, per calendar month.
CPT Codes
Chronic care management CPT codes: 99490, 99439, 99491, 99437, 99487 and 99489
Six codes, split by who performs the time and whether the case meets the complex threshold. The separation that matters most is clinical staff time against practitioner time.
99439
Each additional 20 minutes, clinical staff
Reported with 99490 for each further 20 minutes of clinical staff time in the same calendar month.
99491
Chronic care management, first 30 minutes, practitioner
At least 30 minutes provided personally by the physician or other qualified health professional, per calendar month.
99437
Each additional 30 minutes, practitioner
Reported with 99491 for each further 30 minutes of practitioner time in the same calendar month.
99487
Complex chronic care management, first 60 minutes
At least 60 minutes of clinical staff time, with moderate or high complexity medical decision making, per calendar month.
99489
Each additional 30 minutes, complex
Reported with 99487 for each further 30 minutes of clinical staff time in the same calendar month.
Eligibility
Which patients qualify?
Two or more chronic conditions expected to last at least 12 months or until the death of the patient, and which place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
The risk clause is part of the definition rather than a separate consideration. Two stable, well controlled chronic conditions do not by themselves establish eligibility. The record needs to show why this particular patient carries that risk.
Four elements are required alongside the clinical criteria: patient consent, a comprehensive care plan that is established, implemented, revised and monitored, 24 hour access and continuity of care, and health information recorded electronically.
Time
How is the time counted?
Time is counted per calendar month and cannot be double counted. CMS states it plainly: you cannot count time toward the chronic care management service code for any other billed code.
This is the rule that most often causes trouble on audit. Where a patient is enrolled in several programs, the same telephone call cannot support two claims. The practical consequence is that a program running multiple care management services needs activity level time tracking, not a monthly total.
Do not report 99491 or 99437 in the same calendar month as 99487, 99489, 99490 or 99439. The practitioner time codes and the clinical staff time codes are alternatives for a given month, not additive.
Interactions
Which services cannot run alongside it?
Chronic care management cannot be billed during the same service period as G0181. Either remote patient monitoring or remote therapeutic monitoring may run concurrently, but not both.
Advanced primary care management bundles elements of principal care management, transitional care management and chronic care management, which is why it is not reported alongside them.
Concurrency is code specific and does not generalize from one pairing to another. The chronic care management and transitional care management interaction in particular is narrower than most summaries suggest, and it needs both the transitional care management booklet and the chronic care management billing guidance read together.
Common Questions
Related questions
What is the difference between 99490 and 99491?
Who performs the time. 99490 covers at least 20 minutes of clinical staff time directed by the practitioner. 99491 covers at least 30 minutes provided personally by the physician or other qualified health professional. They are alternatives for a given calendar month and are not reported together.
What makes chronic care management complex?
Complex chronic care management, reported with 99487, requires at least 60 minutes of clinical staff time and moderate or high complexity medical decision making in the month. Both conditions have to be met. Longer time alone does not make a case complex.
Does chronic care management have to be paused during a transitional care management period?
In practice the two generally fall in different calendar months, so the question rarely arises as a pause. Where a transitional care management period ends before month end, at least 20 minutes of qualifying chronic care management furnished after it closes can be reported in that month. Time already counted toward the transitional care management service cannot be counted again.
Is patient consent required?
Yes. Consent must be obtained and documented, and the patient must be informed that cost sharing may apply and that they may stop the service at any time. Consent is one of the required service elements rather than an administrative nicety.
What does general supervision mean here?
CMS describes it as the billing practitioner not personally providing the service, but the service being done under their overall direction and control. The practitioner does not need to be physically present while clinical staff perform the work.
Code descriptors reflect the AMA CPT code set and the CMS HCPCS code set current as of CY2026. Both are revised annually, and Medicare Administrative Contractor and commercial payer policy varies. This page describes what each code covers and the conditions attached to reporting it. It is a reference, not billing advice for a specific claim, and it carries no payment rates.
Related reading
Talk it through with someone who runs these programs
Praventa operates care management programs with its own clinical team and licenses the same platform to practices running them in-house. Describe your situation and we will tell you which model fits.