CPT 99490: CCM, first 20 minutes
The base monthly Chronic Care Management code. It pays for the first 20 minutes of clinical staff time spent coordinating care for a patient with two or more chronic conditions, under the billing practitioner's direction.
CPT 99490 at a glance
- Time threshold
- 20 minutes of clinical staff time per calendar month
- Who performs it
- Clinical staff under the billing practitioner's direction
- How often
- Once per patient per calendar month, by one practitioner
- Approx. 2026 national rate
- ~$66
Not reported in the same month as 99487 or 99491 by the same practitioner for the same patient.
What the record needs to show
- Two or more chronic conditions expected to last at least 12 months or until death, with significant risk of decline
- Documented patient consent (verbal or written) covering cost sharing and the right to stop
- A comprehensive care plan in the record, shared with the patient or caregiver
- A time log showing minutes, who performed them and what was done
- 24/7 access to the care team and continuity with a designated team member
Common billing mistakes
- Billing before the 20-minute threshold is reached; minutes do not roll into next month
- Missing or undated consent, the most common audit gap
- Two practitioners billing CCM for the same patient in the same month
- Counting time that was already part of a separately billed visit
Where Zenith fits
Your practice stays the billing provider for CPT 99490. Zenith supplies trained clinical staff who do the work inside your EHR and invoice your practice for the labor. Zenith does not bill Medicare. See Chronic Care Management for how the program runs.
Educational summary, not billing or legal advice. Rates are 2026 Medicare national averages and vary by locality and payer. Confirm current rules in the CMS Physician Fee Schedule and with your Medicare Administrative Contractor.