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Chronic Care Management (CCM) Billing
Medicare pays care management month by month: chronic care management for patients with two or more chronic conditions, principal care management for one high-risk condition, transitional care management for the 30 days after a discharge, and advanced primary care management for the practice that runs all of a patient’s primary care. Each has its own consent, time, and same-month rules, and a claim that breaks one is denied or recouped in an audit.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly cycle
What care management billing includes
Monthly CCM, PCM, and APCM claims, and the 30-day TCM claim after a discharge.
Chronic care management covers patients with 2 or more chronic conditions expected to last at least 12 months, or until death, that put them at significant risk. Before the first claim the practice needs written or verbal consent, recorded once; an initiating visit for a new patient or one not seen in the past year; a comprehensive electronic care plan shared with the patient; and 24/7 access to the care team. Clinical staff work under general supervision, so the practitioner does not have to be in the room.
Only one practitioner can bill CCM for a patient in a calendar month. Physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives can bill it. FQHCs and rural health clinics are paid for care management outside their encounter rate, except TCM; see FQHC and RHC billing.
What the care management fee covers
- Consent, the initiating visit, and the care plan checked before the first month is billed
- Minutes totaled per patient and calendar month, by code family
- TCM contact and visit dates checked against the discharge date
- Same-month conflicts with RPM, BHI, APCM, and home health supervision flagged
Care management codes and 2026 Medicare rates
National non-facility amounts at the 2026 conversion factor of $33.4009, before the geographic adjustment and the 2% sequestration.
| Code | Service and time | 2026 Medicare national |
|---|---|---|
| 99490 | CCM, clinical staff, first 20 minutes in a calendar month | $66.13 |
| +99439 | CCM, clinical staff, each additional 20 minutes, up to 2 units | $50.44 |
| 99491 | CCM by the physician or NPP personally, first 30 minutes | $89.18 |
| +99437 | CCM by the physician or NPP personally, each additional 30 minutes | $63.13 |
| 99487 | Complex CCM, clinical staff, first 60 minutes, with moderate or high medical decision making | $144.29 |
| +99489 | Complex CCM, each additional 30 minutes | $78.16 |
| 99424, +99425 | PCM by the physician or NPP, first 30 minutes and each additional 30 | $87.51 and $61.46 |
| 99426, +99427 | PCM, clinical staff, first 30 minutes and each additional 30 | $67.80 and $54.11 |
| 99495 | TCM, moderate medical decision making, face-to-face visit within 14 days | $220.11 |
| 99496 | TCM, high medical decision making, face-to-face visit within 7 days | $298.60 |
| G0556, G0557, G0558 | APCM levels 1, 2, and 3, once a month, not time-based | $16.37, $53.78, and $117.24 |
| G0506 | Extensive CCM assessment and care planning, once, with the initiating visit | $66.47 |
The three CCM families do not mix in one month: clinical staff CCM (99490 and 99439), practitioner CCM (99491 and 99437), and complex CCM (99487 and 99489). The 2026 rates include a one-year 2.5% statutory increase that ends on December 31, 2026.
Transitional care management after a discharge
One 30-day claim, paid to the first eligible practitioner who bills it.
Contact within 2 business days
The practitioner or clinical staff reach the patient or caregiver by phone, email, or in person within 2 business days of discharge, counted from the day after. A Monday discharge gives until the end of Wednesday. Two or more documented, timely attempts still count.
Visit within 7 or 14 days
99496 needs high medical decision making and a face-to-face visit within 7 calendar days of discharge; 99495 needs moderate decision making and a visit within 14 days. A late visit means no TCM claim. The visit can be done by telehealth, and it is not billed separately.
Medication reconciliation
Medications are reconciled and managed on or before the date of the face-to-face visit, and the note shows it.
Qualifying discharges
Inpatient acute, psychiatric, rehabilitation, and long-term care hospitals, skilled nursing facilities, observation, and partial hospitalization, with the patient returning home, to assisted living, or to a nursing facility.
Date of service and claim timing
The claim carries the date and place of the face-to-face visit and can go out once that visit happens, without waiting for day 30. If the patient dies before day 30, the visit is billed as an E/M instead.
When TCM is not paid
Medicare pays one TCM per 30-day period, and none when any part of it falls in the same practitioner’s surgical global period. The visit cannot be on the day of discharge management, and the same group cannot bill a second TCM for a readmission within 30 days.
What can be billed in the same month
Medicare rules for one patient and one calendar month. Time and effort are never counted twice.
| Combination | Allowed | Rule |
|---|---|---|
| CCM and TCM | Yes | CCM codes can be billed during the 30-day TCM period, as Medicare has allowed since 2020 |
| CCM and RPM | Yes | Remote physiologic or remote therapeutic monitoring, not both, with separate minutes |
| CCM and behavioral health integration | Yes | With consent for each service and no time counted twice |
| CCM and PCM | Different practitioners only | A primary care practitioner can bill CCM and a specialist PCM for a different condition |
| Two CCM families | No | 99490 and 99439, 99491 and 99437, and 99487 and 99489 are not mixed in a month |
| CCM and home health, hospice, or ESRD codes | No | Not with G0181, G0182, or 90951 to 90970 in the same period |
| APCM and CCM, PCM, or TCM | Different practitioners only | The practitioner billing APCM cannot bill them that month; another practitioner can |
| APCM and BHI, RPM, RTM, CHI, or PIN | Yes | Since 2026, G0568 to G0570 add behavioral health care to APCM for the same practitioner |
Monitoring has its own rules: remote patient monitoring billing · telehealth billing · primary care billing.
Principal and advanced primary care management
Two other monthly codes, and where auditors look first.
Principal care management
PCM is for one high-risk chronic condition expected to last at least 3 months, often managed by a specialist. Each month needs at least 30 minutes, by the practitioner (99424) or clinical staff (99426), and the same practitioner cannot bill PCM and CCM for a patient in the same month.
Advanced primary care management
APCM, billable since January 1, 2025, is for the practitioner responsible for all of a patient’s primary care. It has no time threshold and bills once a month at three levels, set by the number of chronic conditions and Qualified Medicare Beneficiary status. Billing it attests to capabilities such as 24/7 access and population risk stratification, plus Value in Primary Care MVP reporting or a qualifying ACO or model.
Where audits look
OIG opened a 2026 audit of CCM payments at risk of not meeting the two-chronic-condition requirement. MAC reviews have denied CCM for undocumented minutes, incomplete consent, and no care plan, and reduced 99496 to 99495 when high decision making was not supported.
Not inside the monthly fee
The monthly cycle bills claims that are already in the system. These are scoped on their own.
Written rate
The fee is a percentage of net collections (flat or per claim in New York). No setup fee on the monthly cycle. Month to month. The written rate follows volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
Separate work
Care coordinators, the 24/7 line, and the care plan itself stay with the practice. A retrospective audit of past CCM or TCM claims is scoped on its own.
Audit a month of care management claims
Send a month of CCM, PCM, and TCM claims with the minutes log, consent dates, and discharge and visit dates. We report months billed under the wrong code family, TCM claims outside the 7 or 14 days, same-month conflicts, and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Care management billing questions
Straight answers on CCM, PCM, TCM, and APCM claims.
How many minutes are needed to bill CCM?
20 minutes of clinical staff time in a calendar month for 99490, with each additional 20 minutes billed as 99439, up to two units. 30 minutes of the practitioner’s own time bills 99491. Complex CCM, 99487, starts at 60 minutes of clinical staff time with moderate or high medical decision making.
Does CCM consent have to be renewed every year?
No. Written or verbal consent is obtained once before CCM starts and documented, covering cost sharing, the one-practitioner-per-month rule, and the right to stop. A new consent is needed only if the patient changes billing practitioners.
What is the difference between 99495 and 99496?
Both are transitional care management for the 30 days after a discharge, with contact within 2 business days. 99495 needs at least moderate medical decision making and a face-to-face visit within 14 days. 99496 needs high medical decision making and a visit within 7 days.
Can CCM and TCM be billed in the same month?
Yes. Since 2020, Medicare allows CCM during the 30-day TCM period, as long as the requirements for each are met and no time is counted twice.
Can CCM and RPM be billed for the same patient?
Yes, when the minutes are separate. Time used for remote patient monitoring management cannot also count toward CCM, and a patient can have remote physiologic or remote therapeutic monitoring with CCM, but not both.
Can an FQHC or rural health clinic bill CCM?
Yes. Care management services, except transitional care management, are paid separately at physician fee schedule rates, outside the FQHC prospective payment and the RHC all-inclusive rate. Health centers can also bill APCM at the non-facility rate.
How is the fee set?
As a percentage of net collections (flat or per claim in New York) on the book you hand over. No setup fee on the monthly cycle, month to month, with 30 days’ written notice. The written rate follows volume, payer mix, and scope.