CPT code 99490: Non-complex chronic care management (CCM) services

What is code 99490?

CPT code 99490 is defined as non-complex chronic care management (CCM) services provided by clinical staff under the direction of a physician or other qualified healthcare professional, for at least 20 minutes of care coordination per calendar month. It applies to patients with two or more chronic conditions expected to last at least 12 months (or until death) and that place the patient at significant risk of acute exacerbation, decompensation, or functional decline.

The services covered under 99490 include structured care coordination, medication management, coordination with community and health resources, and regular review and updating of a personalized electronic care plan.

Documentation requirements

Proper documentation is essential to support medical necessity and ensure proper reimbursement for 99490. The following elements must be reflected in the patient’s medical record:

• Initiating visit: A face-to-face visit—such as an evaluation and management (E/M) service, annual wellness visit, or preventive exam—must occur before billing CCM services. This initiating visit must include a comprehensive discussion of CCM and documented patient consent.
• Chronic condition eligibility: The patient must have two or more chronic conditions that are expected to persist for at least 12 months or until the patient’s death and place them at risk for functional decline, acute exacerbation, or hospitalization.
• Structured care plan: A comprehensive, patient-centered care plan must be developed and electronically recorded. It should address diagnoses, treatment goals, medication management, social needs, and coordination with other providers.
• Patient consent: Obtain and document verbal or written consent for CCM services, including informing the patient of possible cost-sharing and their right to stop services at any time.
• Time tracking: At least 20 minutes of clinical staff time per month must be documented, including specific activities performed under the direction of a qualified healthcare professional.
• Continuity and coordination of care: Documentation should show care coordination, communication with the patient or caregiver, and any updates to the care plan or health goals.
• Use of certified electronic health record (EHR): Services must be documented and managed using a certified EHR to ensure care continuity and interoperability.

Billing guidelines

Accurate billing for CPT 99490, which represents non-complex chronic care management services, requires full compliance with Medicare, Medicaid, and commercial payer policies. The code reflects care management CPT services delivered by clinical staff under the direction of a qualified health care professional billed per calendar month. Below are the key billing considerations to follow:

One billing per patient per calendar month

CPT 99490 can be billed only once per patient per calendar month and only by a single provider or group. No other qualified health care provider may submit a claim for CCM services for the same service period. This ensures coordinated and centralized care for the patient and prevents duplicate billing.

Clinical staff time directed by a qualified provider

As mentioned, to bill 99490, at least 20 minutes of clinical staff must be spent performing non-face-to-face chronic care management services under the general supervision of a physician or other qualified health care professional. Supervision may be remote, and staff may include nurses, medical assistants, or other trained personnel working within their scope of practice.

Place of service and care setting

CCM services under 99490 are billable in outpatient settings, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). As directed by CMS, HCPCS code G0511 should be used instead of 99490 in these settings. Claims must reflect the appropriate place of service code and align with EHR and compliance documentation.

Avoid overlap with other care management CPT codes

CPT 99490 cannot be billed during the same month as other time-based care management CPT codes such as 99491, 99487, 99489, 99437, or 99439. Unless specifically allowed by payer policy, these codes are considered mutually exclusive due to overlapping care components.

Medicaid coverage

Coverage of chronic care management CPT code 99490 under Medicaid services varies by state. Some Medicaid programs reimburse 99490 directly, while others use state-specific CCM codes or alternative billing requirements. It’s essential to confirm coverage, documentation expectations, and time-tracking rules with your state Medicaid agency or managed care plan.

Other relevant CPT codes

• 99439: Additional 20 minutes of CCM clinical staff time (add-on to 99490)
• 99491: Non-complex chronic care management provided personally by a physician or qualified professional, at least 30 minutes of physician or other qualified healthcare professional time
• 99487: Complex chronic care management, 60 minutes of clinical staff time