CPT code 99490: Chronic care management, clinical staff, first 20 minutes2026 Medicare rate & RVUs in Oregon
Monthly clinical staff care management for patients with at least two qualifying chronic conditions, reported after 20 minutes in a calendar month.
Medicare pays $65.32–$69.44 for 99490 in the office in Oregon, from Rest of Oregon to Portland, OR. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland, OR | $69.44 | $44.58 |
| Rest of Oregon | $65.32 | $43.03 |
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.
How the rate is built · 99490
RVUs × geographic indexes × conversion factor
Work1.00
1.00 RVUs× 1.000 GPCI
Practice expense0.91
0.91 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
1.9800
Conversion factor
$33.4009
Medicare rate
$66.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99490
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$66.13
- Non-facility (office)
- $66.13
- Facility
- $43.76
Higher because the practice carries its own overhead.
99490 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99490 billing questions
How does 99490 differ from 99491?
99490 counts clinical staff time directed by the billing practitioner, with a 20-minute threshold. 99491 requires at least 30 minutes personally spent by the physician or qualified health care professional.
Can 99490 and 99487 be billed in the same month?
No. Complex CCM under 99487 requires at least 60 minutes of staff time, moderate or high complexity medical decision making, and establishment or substantial revision of the care plan. Report the code supported by that month's work.
How is time beyond the first 20 minutes reported?
Report 99439 with 99490 for each additional full 20 minutes of clinical staff time in the calendar month. The first additional unit requires at least 40 total minutes.
What consent documentation is needed?
Record that the patient agreed, verbally or in writing, to receive CCM and was informed about cost sharing and the right to stop the service. Obtain consent before the first billed month.
Can 99490 be billed with transitional care management?
Yes. CCM and transitional care management under 99495 or 99496 may be reported for the same month when each service's requirements are met. Do not count the same minutes toward both.
Does face-to-face visit time count toward the 20 minutes?
Do not count time spent furnishing a separately billed E/M visit. Count documented clinical staff time spent on qualifying CCM activities, whether those activities occur in person or remotely.
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
Show the CMS file lines behind this rate
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