CCM Guide: 2026 Codes, Requirements & Billing Rules

What is Chronic Care Management (CCM)?

Chronic Care Management (CCM) is a Medicare care-management service for patients with two or more chronic conditions expected to last at least 12 months, or until death, that create significant risk of decline. It is organized around a comprehensive care plan and the coordination that happens between visits.

Which patients qualify for CCM?

A patient has two or more chronic conditions expected to last at least 12 months, or until death.
Those conditions create significant risk of decline, an acute episode, or other serious consequences.
The patient would benefit from an organized care plan and regular coordination across clinicians, medicines, appointments, and practical needs.

What are the CCM codes?

The CCM codes are 99490, 99439, 99487, 99489, 99491 and 99437.

Code	Covers	2026 national office benchmark
99490	Clinical staff: 20+ minutes / month	$66.13 / patient month
99439	Clinical staff: Each additional 20 minutes	$50.44 / additional 20 min
99487	Complex CCM: 60+ minutes / month	$144.29 / patient month
99489	Complex CCM: Each additional 30 minutes	$78.16 / additional 30 min
99491	Clinician personally: 30+ minutes / month	$89.18 / patient month
99437	Clinician personally: Each additional 30 minutes	$63.13 / additional 30 min

Choose one CCM pathway for a patient in a calendar month. Eligibility, consent, a care plan and the other service requirements still apply. Add-on codes require completed extra time and are not included in the base-code estimates.

2026 Medicare allowed amounts, national office/nonfacility benchmark, non-QP conversion factor. Includes applicable patient cost sharing; before practice costs and MySeema fees. Actual collections vary with location, setting, clinician, coverage, and claim adjustments. See the rate source and estimate your practice.

CCM billing rules

Select one base pathway: 99490 for 20+ clinical-staff minutes; 99487 for 60+ complex-care minutes with moderate/high-complexity medical decision making and an established or substantially revised care plan; or 99491 for 30+ minutes personally provided by the billing practitioner.
One billing practitioner per patient per calendar month; consent and comprehensive electronic care plan required.
Initiating visit for a new patient or one not seen in the prior year.
Maintain 24/7 access, continuity, coordination and record-sharing capabilities.
Do not combine staff-led, practitioner-personal, or complex CCM pathways in one month.
Exclude same-period home-health/hospice supervision G0181/G0182 and ESRD 90951–90970.

Patient cost sharing and protections depend on coverage and the service. Explain them before consent. RHC/FQHC payment rules and Medicare Advantage contracts differ from the national benchmark.

What a practice needs before starting CCM

Defined eligible population and billing practitioner
Comprehensive care-plan ownership and clinical escalation path
Patient introduction, consent, and cost-sharing workflow
Approved record access and documentation standards
Review of overlapping services, personnel rules, and billing responsibility

Who does what in a supported CCM program

Your practice or organization

Confirm eligibility, establish and direct the comprehensive care plan, and make clinical decisions.
Define supervision, escalation, record access, consent, cost-sharing communication, and any required coverage arrangements.
Review documentation and submit only claims supported by the services actually furnished under current rules.

A support partner such as MySeema

Introduce the service through the partner-approved patient experience and support enrollment and consent workflows.
Follow the agreed care-plan tasks, including appointments, referrals, refill requests, and barriers such as transportation.
Document the work in the partner workflow, surface clinical concerns, and report completed care touches and open next steps.

Your clinicians keep clinical decisions and oversight, and your organization bills eligible services.

What changes for CCM in 2027?

The benchmarks on this page are 2026 amounts. Medicare’s 2027 conversion factor is lower ($32.63 for most clinicians, down 2.31%), so 2027 payment amounts will differ. Read what the 2027 fee schedule changes.

Common questions about CCM

Is CCM simply a monthly check-in call?

No. CCM is organized around a comprehensive care plan for qualifying patients. The actual work may include coordination, follow-up, medication-related communication, and access to the care team, with documentation that supports the service provided.

Can MySeema make treatment changes?

Treatment decisions remain with the appropriate clinician. MySeema carries the work assigned in the partner workflow and routes clinical concerns through the agreed escalation path.

Can CCM be combined with every other program?

No blanket combination rule is safe. Some services have bundling or concurrent-billing limits, and the same work or time cannot be counted twice. The billing organization should verify current rules for each patient.

This guide summarizes Medicare requirements for planning. It is not a billing manual or a promise of reimbursement. Confirm requirements with your billing and compliance teams.

Chronic Care Management (CCM): codes, requirements, and how it works