CPT code 99490: Chronic care management, clinical staff, first 20 minutes2026 Medicare rate & RVUs

Medicare pays $66.13 for 99490 nationally in the office and $43.76 in a hospital or facility. Local office rates run $60.71–$83.76.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99490 covers

This service coordinates care for patients with at least two chronic conditions expected to last 12 months or until death and posing significant risk of death, acute exacerbation, or functional decline. Clinical staff working under a physician or qualified health care professional may review medications, update the care plan, coordinate with specialists or home health, and follow up by phone or portal. Primary care and internal medicine practices commonly furnish this care between visits.

Report 99490 once per calendar month when clinical staff time reaches 20 minutes; report each additional full 20 minutes with 99439. Document consent, qualifying conditions, the comprehensive care plan, activities performed, and the time spent. For new patients or those not seen in the prior year, CMS requires an initiating face-to-face visit, such as an E/M visit, annual wellness visit, or initial preventive physical examination. Staff may furnish CCM under general supervision. Only one practitioner may bill CCM for a patient in a calendar month.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99490 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99490 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99490 rate is calculated

Each of 99490’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99490

99490 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99490 compared with similar codes

How to choose

99491Chronic care management30 minutes, physician/QHP time

Choose 99491 for at least 30 minutes of CCM personally performed by the physician or qualified health care professional; 99490 is based on at least 20 minutes of directed clinical staff time.

99487Complex chronic care managementClinical staff, first 60 minutes

99487 requires at least 60 minutes of staff time, moderate or high complexity medical decision making, and establishment or substantial revision of the comprehensive care plan. Use 99490 when its requirements are met instead.

99424Principal care managementPhysician/QHP, first 30 minutes

99424 is based on physician or qualified health care professional time managing one qualifying high-risk chronic condition. 99490 requires clinical staff time managing at least two qualifying chronic conditions.

99484Behavioral health managementGeneral integration service

99484 covers general behavioral health integration for a behavioral health condition. 99490 covers comprehensive care management for at least two qualifying chronic conditions, which may include behavioral health conditions.

Codes related to 99490

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates