$82.64–$115.23
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.
On this page
CMS RVU26D · Effective 2026-10-01
99490 Chronic care management Medicare reimbursement rates
Monthly clinical staff care management for patients with at least two qualifying chronic conditions, reported after 20 minutes in a calendar month. Compare 99490 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99490?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$60.71–$83.76
109 of 109 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 99490 pays more and less
109 payment localities
$60.71 to $83.76
Care management
About 99490: Chronic care management, clinical staff first 20 minutes
Monthly clinical staff care management for patients with at least two qualifying chronic conditions, reported after 20 minutes in a calendar month.
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.
Where the value comes from
- Work RVU1.00 · 51%
- Practice expense (office) RVU0.91 · 46%
- Malpractice RVU0.07 · 4%
6.9M
Medicare services in 2024 · #29 by national volume
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.
99490 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$130.98–$184.06
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.
$80.74–$112.38
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.
$53.04–$73.67
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.
See how rates vary across the country
99490 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$60.71
$83.76
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $83.76 | 1 |
| AL | $61.32 | 1 |
| AR | $60.71 | 1 |
| AZ | $64.85 | 1 |
| CA | $68.53–$82.16 | 29 |
| CO | $67.97 | 1 |
| CT | $69.63 | 1 |
| DC | $73.61 | 1 |
| DE | $65.70 | 1 |
| FL | $65.97–$70.95 | 3 |
| GA | $63.30–$67.19 | 2 |
| GU | $69.31 | 1 |
| HI | $69.31 | 1 |
| IA | $62.14 | 1 |
| ID | $62.47 | 1 |
| IL | $64.81–$69.55 | 4 |
| IN | $62.71 | 1 |
| KS | $62.06 | 1 |
| KY | $62.56 | 1 |
| LA | $62.54–$64.66 | 2 |
| MA | $67.80–$73.14 | 2 |
| MD | $66.64–$73.61 | 3 |
| ME | $62.82–$65.00 | 2 |
| MI | $63.79–$66.67 | 2 |
| MN | $65.37 | 1 |
| MO | $61.88–$64.68 | 3 |
| MS | $61.30 | 1 |
| MT | $66.13 | 1 |
| NC | $63.25 | 1 |
| ND | $64.74 | 1 |
| NE | $62.34 | 1 |
| NH | $67.09 | 1 |
| NJ | $70.49–$73.26 | 2 |
| NM | $64.08 | 1 |
| NV | $65.77 | 1 |
| NY | $63.92–$76.02 | 5 |
| OH | $63.51 | 1 |
| OK | $62.36 | 1 |
| OR | $65.32–$69.44 | 2 |
| PA | $63.51–$68.43 | 2 |
| PR | $66.43 | 1 |
| RI | $67.52 | 1 |
| SC | $63.47 | 1 |
| SD | $64.58 | 1 |
| TN | $62.29 | 1 |
| TX | $63.23–$67.70 | 8 |
| UT | $64.07 | 1 |
| VA | $64.93–$73.61 | 2 |
| VI | $66.43 | 1 |
| VT | $64.67 | 1 |
| WA | $67.62–$74.28 | 2 |
| WI | $63.24 | 1 |
| WV | $63.16 | 1 |
| WY | $65.53 | 1 |
Compare 99490 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $61.32 | Facility $41.74 |
| Alaska* | Office $83.76 | Facility $59.93 |
| Arizona | Office $64.85 | Facility $43.17 |
| Arkansas | Office $60.71 | Facility $41.49 |
| Atlanta | Office $67.19 | Facility $44.45 |
| Austin | Office $67.70 | Facility $44.02 |
| Bakersfield | Office $68.77 | Facility $44.25 |
| Baltimore/Surr. Cntys | Office $69.44 | Facility $45.43 |
| Beaumont | Office $63.23 | Facility $42.87 |
| Brazoria | Office $65.61 | Facility $43.44 |
| Chicago | Office $69.55 | Facility $47.06 |
| Chico | Office $68.53 | Facility $44.01 |
| Colorado | Office $67.97 | Facility $44.16 |
| Connecticut | Office $69.63 | Facility $45.53 |
| Dallas | Office $65.98 | Facility $43.69 |
| Dc + Md/Va Suburbs | Office $73.61 | Facility $47.25 |
| Delaware | Office $65.70 | Facility $43.59 |
| Detroit | Office $66.67 | Facility $45.08 |
| East St. Louis | Office $66.07 | Facility $45.48 |
| El Centro | Office $68.55 | Facility $44.02 |
| Fort Lauderdale | Office $68.42 | Facility $45.75 |
| Fort Worth | Office $65.71 | Facility $43.64 |
| Fresno | Office $68.53 | Facility $44.01 |
| Galveston | Office $65.79 | Facility $43.56 |
| Hanford-Corcoran | Office $68.53 | Facility $44.01 |
| Hawaii, Guam | Office $69.31 | Facility $43.87 |
| Houston | Office $67.07 | Facility $44.85 |
| Idaho | Office $62.47 | Facility $41.88 |
| Indiana | Office $62.71 | Facility $41.97 |
| Iowa | Office $62.14 | Facility $41.66 |
| Kansas | Office $62.06 | Facility $41.83 |
| Kentucky | Office $62.56 | Facility $42.67 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $72.28 | Facility $45.81 |
| Madera | Office $68.53 | Facility $44.01 |
| Manhattan | Office $74.57 | Facility $48.56 |
| Merced | Office $68.53 | Facility $44.01 |
| Metropolitan Boston | Office $73.14 | Facility $46.42 |
| Metropolitan Kansas City | Office $64.23 | Facility $43.21 |
| Metropolitan Philadelphia | Office $68.43 | Facility $45.14 |
| Metropolitan St. Louis | Office $64.68 | Facility $43.38 |
| Miami | Office $70.95 | Facility $47.66 |
| Minnesota | Office $65.37 | Facility $42.34 |
| Mississippi | Office $61.30 | Facility $42.03 |
| Modesto | Office $68.53 | Facility $44.01 |
| Montana** | Office $66.13 | Facility $43.75 |
| Napa | Office $76.75 | Facility $47.26 |
| Nebraska | Office $62.34 | Facility $41.68 |
| Nevada** | Office $65.77 | Facility $43.37 |
| New Hampshire | Office $67.09 | Facility $43.79 |
| New Mexico | Office $64.08 | Facility $43.56 |
| New Orleans | Office $64.66 | Facility $43.60 |
| North Carolina | Office $63.25 | Facility $42.37 |
| North Dakota** | Office $64.74 | Facility $42.37 |
| Northern Nj | Office $73.26 | Facility $47.30 |
| Nyc Suburbs/Long Island | Office $76.02 | Facility $49.41 |
| Ohio | Office $63.51 | Facility $43.08 |
| Oklahoma | Office $62.36 | Facility $42.38 |
| Oxnard-Thousand Oaks-Ventura | Office $71.72 | Facility $45.27 |
| Portland | Office $69.44 | Facility $44.58 |
| Poughkpsie/N Nyc Suburbs | Office $71.02 | Facility $46.51 |
| Puerto Rico | Office $66.43 | Facility $43.81 |
| Queens | Office $74.84 | Facility $48.39 |
| Redding | Office $68.53 | Facility $44.01 |
| Rest Of California | Office $68.53 | Facility $44.01 |
| Rest Of Florida | Office $65.97 | Facility $44.58 |
| Rest Of Georgia | Office $63.30 | Facility $43.34 |
| Rest Of Illinois | Office $64.81 | Facility $44.37 |
| Rest Of Louisiana | Office $62.54 | Facility $42.74 |
| Rest Of Maine | Office $62.82 | Facility $42.23 |
| Rest Of Maryland | Office $66.64 | Facility $43.99 |
| Rest Of Massachusetts | Office $67.80 | Facility $44.24 |
| Rest Of Michigan | Office $63.79 | Facility $43.36 |
| Rest Of Missouri | Office $61.88 | Facility $42.59 |
| Rest Of New Jersey | Office $70.49 | Facility $46.06 |
| Rest Of New York | Office $63.92 | Facility $42.66 |
| Rest Of Oregon | Office $65.32 | Facility $43.03 |
| Rest Of Pennsylvania | Office $63.51 | Facility $42.97 |
| Rest Of Texas | Office $64.36 | Facility $43.12 |
| Rest Of Washington | Office $67.62 | Facility $44.06 |
| Rhode Island | Office $67.52 | Facility $44.40 |
| Riverside-San Bernardino-Ontario | Office $69.31 | Facility $44.78 |
| Sacramento-Roseville-Folsom | Office $71.21 | Facility $45.18 |
| Salinas | Office $70.92 | Facility $44.98 |
| San Diego-Chula Vista-Carlsbad | Office $72.02 | Facility $45.26 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $80.50 | Facility $48.95 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $80.42 | Facility $48.87 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $82.16 | Facility $49.89 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $81.83 | Facility $49.56 |
| San Luis Obispo-Paso Robles | Office $69.84 | Facility $44.35 |
| Santa Cruz-Watsonville | Office $72.29 | Facility $45.10 |
| Santa Maria-Santa Barbara | Office $71.03 | Facility $44.94 |
| Santa Rosa-Petaluma | Office $72.98 | Facility $45.50 |
| Seattle (King Cnty) | Office $74.28 | Facility $46.82 |
| South Carolina | Office $63.47 | Facility $42.80 |
| South Dakota** | Office $64.58 | Facility $42.20 |
| Southern Maine | Office $65.00 | Facility $42.82 |
| Stockton | Office $68.53 | Facility $44.01 |
| Suburban Chicago | Office $68.99 | Facility $46.01 |
| Tennessee | Office $62.29 | Facility $41.94 |
| Utah | Office $64.07 | Facility $43.04 |
| Vallejo | Office $76.64 | Facility $47.14 |
| Vermont | Office $64.67 | Facility $42.52 |
| Virgin Islands | Office $66.43 | Facility $43.81 |
| Virginia | Office $64.93 | Facility $42.93 |
| Visalia | Office $68.53 | Facility $44.01 |
| West Virginia | Office $63.16 | Facility $43.71 |
| Wisconsin | Office $63.24 | Facility $41.80 |
| Wyoming** | Office $65.53 | Facility $43.15 |
| Yuba City | Office $68.53 | Facility $44.01 |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,15199486,,Suprv interfac trnsport addl,B,+,1.30,0.29,NA,0.29,,0.07,1.66,1.66,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15299487,,Cplx chrnc care 1st 60 min,A,,1.81,2.38,,0.43,,0.13,4.32,2.37,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15399489,,Cplx chrnc care ea addl 30,A,,1.00,1.27,,0.24,,0.07,2.34,1.31,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15499490,,Chrnc care mgmt staff 1st 20,A,,1.00,0.91,,0.24,,0.07,1.98,1.31,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15599491,,Chrnc care mgmt phys 1st 30,A,,1.50,1.08,,0.37,,0.09,2.67,1.96,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15699492,,1st psyc collab care mgmt,A,,1.88,2.78,,0.44,,0.14,4.80,2.46,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15799493,,Sbsq psyc collab care mgmt,A,,2.05,2.15,,0.49,,0.14,4.34,2.68,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00