CPT Code 99490 | Reimbursement Guide | Prevounce

Chronic care management (CCM) plays a crucial role in helping patients with multiple chronic conditions stay healthier and avoid unnecessary hospital visits. With structured care plans, regular check-ins, and better coordination between providers, patients receive the support they need to manage their conditions more effectively. At the same time, CCM helps practices deliver high-quality, proactive care while ensuring they’re reimbursed for the time spent keeping patients engaged in their health.

To ensure appropriate reimbursement for chronic care management services, providers must understand and correctly apply the CCM CPT codes. In this post, we’ll take a closer look at CPT code 99490, discussing topics including what it covers, rules for its use, billing requirements, and best practices.

What Is CPT Code 99490?

CPT 99490 is the primary, entry-level billing code under the Centers for Medicare & Medicaid Services’ (CMS) chronic care management program. This code allows providers to be reimbursed for delivering non-face-to-face care coordination services to patients with multiple chronic conditions. 

CPT 99490 is for at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional (QHP). 99490 is for non-complex chronic care management services provided to Medicare beneficiaries with two or more chronic conditions. These services include:

• Creating and maintaining comprehensive care plans
• Coordinating care between providers
• Regular patient follow-ups and medication management

In 2025, CPT code 99490’s national average non-facility reimbursement rate is about $60.

Who Can Bill for CPT 99490?

CMS notes that that the following physicians and non-physician practitioners can bill CPT 99490:

• Physicians (MDs)
• Certified nurse midwives (CNMs) 
• Clinical nurse specialists (CNSs)
• Nurse practitioners (NPs)
• Physician assistants (PAs)

General Supervision

When CCM services are delivered by clinical staff, they are provided under the general supervision of the billing practitioner. This means that while the billing practitioner oversees and directs the services, they do not need to be physically present during service delivery. Clinical staff can include employees or contracted professionals who perform CCM tasks as an extension of the billing provider.

CMS designates CCM codes such as CPT 99490 under general supervision within the Medicare Physician Fee Schedule (PFS). This classification ensures flexibility in service delivery while maintaining compliance with Medicare guidelines. As long as state laws, licensure, and scope of practice requirements are met, clinical staff can effectively manage CCM services, allowing providers to extend their care management and billing capabilities.

Patient Eligibility for CPT 99490

Patients eligible for CPT 99490 services must have two or more chronic conditions expected to persist for at least 12 months or until death. These conditions should pose a significant risk of severe health deterioration, including hospitalization or functional decline.

Services covered by CPT code 99490 are primarily non-face-to-face, allowing providers to deliver care coordination efficiently while ensuring ongoing patient support. Billing practitioners should proactively identify candidates for CCM using Medicare eligibility data and key indicators outlined in CPT guidance. Any condition that meets the Medicare criteria can qualify a patient for CCM. 

Common conditions eligible for CPT 99490 services include the following:

• Hypertension
• Diabetes 
• Chronic heart failure (CHF)
• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Cardiovascular disease
• Depression

Note: To learn more about CCM patient eligibility, download this guide.

CPT 99490 Billing Requirements

Understanding the billing requirements for CPT 99490 is essential to ensure compliance and reimbursement. Providers must meet several key criteria to ensure proper billing of the 99490 CPT code. 

Initiating Visit

A face-to-face initiating visit is required for new chronic care management patients or those not seen within the past 12 months. This visit must occur during an E/M visit, annual wellness visit (AWV), or initial preventive physical exam (IPPE). If the provider does not discuss CCM during one of these encounters, the visit does not qualify.

Patient Consent

Providers must obtain written or verbal consent before billing, ensuring patients understand:

• Availability of CCM services
• Cost-sharing responsibilities
• That only one provider can bill for CCM per month
• Their right to discontinue services anytime (effective at month’s end)

Consent is required only once unless the patient changes CCM providers.

Comprehensive Care Plan

The provider must develop and maintain an electronic, patient-centered care plan that includes:

• Physical, mental, and functional health assessments
• Caregiver and resource support inventory
• A copy provided to the patient and caregivers
• Electronic documentation for seamless provider access

Time Spent 

CPT 99490 requires at least 20 minutes of non-face-to-face clinical staff time per month under the direction of a physician or other qualified healthcare professional.

Interactive Communication

To bill for 99490, services must include structured care coordination and ongoing patient communication, including phone calls or other (real time) electronic interactions to support chronic care management. 

Access to Care and Continuity

Providers must ensure:

• 24/7 patient access to clinical staff for urgent needs
• Continuity of care with a designated care team member
• Secure communication via phone, messaging, or a patient portal

Note: For a comprehensive guide on billing and coding for 99490 and other chronic care management codes, download this Chronic Care Management Coding and Billing Guide.

CPT Code 99490 Compared to Other CCM CPT codes

CPT 99490 is part of the larger CCM billing structure. Understanding how 99490 fits within this structure is essential for proper coding, billing, and reimbursement for chronic care management. Below is a table identifying the set of CCM CPT codes and key information about each code.

*CPT codes 99487, 99489, and 99490 include time spent directly by the billing practitioners or clinical staff. Time spent by the billing practitioner may also count toward the time threshold if not used to report 99491. 

**CPT code 99491 includes only time that’s spent personally by the billing practitioner. Clinical staff time does not count toward the required reporting time threshold code.

Integrating 99490 With Remote Patient Monitoring (RPM)

Many providers pair remote patient monitoring (RPM) with time-based CCM codes like 99490 as part of a larger, more comprehensive care management program to enhance patient care and increase reimbursement. RPM CPT code 99454 covers the device supply and 16 days of transmitted health data, while CCM codes like CPT 99490 and 99439 reimburse for time spent reviewing data, adjusting treatment plans, and patient communication. This combination better ensures continuous monitoring with proactive management, leading to improved health outcomes and higher practice revenue.

Here is what the described combination of RPM and CCM services would look like from a coding and billing perspective:

Best Practices for CPT 99490

Implementing best practices for CPT 99490 helps ensure program efficiency, patient engagement, and ongoing compliance with CMS guidelines. The following is a few important best practices to take follow when developing a chronic care management program:

• Identify eligible patients early: Use EHR systems to flag CCM-qualified patients.
• Develop clear care plans: Tailor plans to individual patient needs and goals.
• Ensure proper documentation: Maintain accurate records to avoid audit risks.
• Utilize CCM software: Streamline workflows and track patient interactions efficiently.
• Educate patients: Clearly explain CCM benefits to improve engagement and enrollment.

Get More Out of CPT 99490: Speak With Our Care Management Experts

Schedule a demo with Prevounce to see how our platform simplifies chronic care management coding and billing, improves CCM compliance, automates tracking, and helps providers achieve improved patient outcomes and financial performance. Book your demo today and take control of your care management program.

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Disclaimer

Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.

Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.

Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.