CPT 99490

Definition

CPT 99490 is the Medicare billing code for the first 20 minutes of clinical staff time spent on non-complex Chronic Care Management activities for a patient in a calendar month, reimbursed at approximately $66 and requiring two or more chronic conditions plus documented patient consent. It is the base code in the CCM billing family and must be billed before any add-on codes apply.

CPT 99490 is billed once per calendar month per patient when at least 20 minutes of clinical staff time on CCM activities have been documented. Time must be non-face-to-face — minutes spent during evaluation and management visits do not count toward the 20-minute threshold. The 2026 Medicare national average reimbursement is approximately $66 per patient per month; rates are updated annually and providers should verify current figures on CMS.gov before projecting program revenue.

Regulatory basis

CPT 99490 was established by CMS under the Medicare Physician Fee Schedule as part of the CCM code family (99490, 99439, 99487, 99489). CMS policy requires a comprehensive care plan, 24/7 patient access to care, and documented patient consent before billing. The authoritative guidance is the CMS MLN Chronic Care Management Services booklet, which details documentation requirements, consent standards, and time-tracking rules.

Annual updates to CCM billing policy are published in the Medicare Physician Fee Schedule final rule. The non-complex designation distinguishes 99490 from the complex CCM codes (99487/99489), which require higher-complexity medical decision making and physician-directed time rather than clinical staff time.

Who uses it and when it applies

• Physicians or qualifying non-physician practitioners (NPs, PAs, CNSs, CNMs) billing CCM for their panel patients
• Clinical staff (RNs, LPNs, medical assistants) under general supervision performing CCM activities that count toward the monthly time requirement
• Patients with two or more chronic conditions expected to last at least 12 months and placing the patient at significant risk of death, exacerbation, or functional decline
• Billed once per calendar month per patient when cumulative clinical staff time reaches 20 minutes and documented patient consent is on file

Related terms

• CPT 99439 — each additional 20 minutes of non-complex CCM clinical staff time in the same calendar month
• CPT 99487 — complex CCM 60 minutes, an alternative track for higher-complexity patients requiring physician-directed time
• Chronic Care Management — the broader care model CPT 99490 operationalizes
• Care coordination — the function CCM supports through structured patient outreach and care-plan management

How Positive Check relates

Positive Check supports CCM by generating structured wellness call summaries that make the 20-minute clinical staff review productive — concentrating time on care plan action and documentation rather than data gathering. See the Chronic Care Management solution for the full workflow, or the CPT 99490 billing guide for documentation and time-tracking requirements.