Billing reference • CCM CPT Codes • 2026

2026 Chronic Care Management (CCM)CPT Codes

A comprehensive guide to 2026 CCM CPT codes, including standard, complex, and physician-driven care coordination services with time requirements and billing scenarios.

Effective: Jan 1, 2026CMS PFS (reference)For patients with 2+ chronic conditions

CCM CPT Codes Overview

Chronic Care Management (CCM) enables practices to bill for coordinated care activities for patients with two or more chronic conditions expected to last at least 12 months or until death. CMS supports CCM with three distinct code series based on service level and complexity.

In 2026, CMS continued to support CCM with modest reimbursement increases while retaining the same code structure. Practices can choose the appropriate CCM series based on time requirements and clinical complexity.

Complete CCM CPT Codes Table (2026)

Reference table with all CCM codes organized by category: Standard CCM, Complex CCM, and Physician-Driven CCM. Each category includes base codes and add-on codes for additional time.

Standard CCM (Non-Complex)
Basic chronic care coordination by clinical staff
CodeDescriptionThreshold
99490
Basic chronic care coordination by clinical staff
≥ 20 minutes
per calendar month
99439
Additional staff time for basic CCM
+20 minutes increments
add-on to 99490
Complex CCM
Higher complexity coordination requiring clinical decision support
CodeDescriptionThreshold
99487
Higher complexity coordination requiring clinical decision support
≥ 60 minutes
per calendar month
99489
Additional time for complex CCM
+30 minutes increments
add-on to 99487
Physician-Driven CCM
Physician or qualified professional personally provides CCM
CodeDescriptionThreshold
99491
Physician or qualified professional personally provides CCM
≥ 30 minutes
per calendar month
99437
Extra time for physician-led CCM
+30 minutes increments
add-on to 99491

Standard CCM: 99490 & 99439

99490 - Standard CCM (Base Code)

  • Requires at least 20 cumulative minutes of care coordination activities per calendar month
  • Delivered by clinical staff under physician supervision
  • For patients with two or more chronic conditions expected to last 12+ months
  • Billed once per calendar month
Care coordination activities include
Care plan development and implementation
Medication management and reconciliation
Care coordination with other providers
Patient and caregiver communication

99439 - Standard CCM Add-On

  • Used when time exceeds the base 20-minute threshold
  • Billed for each additional 20-minute increment
  • Up to two units per month (40-60 minutes total)
  • Must be billed with 99490 in the same month

Complex CCM: 99487 & 99489

99487 - Complex CCM (Base Code)

  • Requires at least 60 minutes of clinical staff time per calendar month
  • For patients with higher care needs requiring more clinical judgment
  • Involves complex care coordination and decision-making beyond standard CCM
  • Billed once per calendar month

99489 - Complex CCM Add-On

  • Billed for each additional 30-minute increment beyond the base 60 minutes
  • No stated limit on how many times it may be used in a month
  • Must be billed with 99487 in the same month

Physician-Driven CCM: 99491 & 99437

99491 - Physician-Driven CCM (Base Code)

  • Used when the physician or qualified healthcare provider personally provides CCM
  • Requires at least 30 minutes of direct clinician time per calendar month
  • Clinician directly carries out chronic care tasks (not delegated to clinical staff)
  • Billed once per calendar month

99437 - Physician CCM Add-On

  • Billed for each additional 30-minute increment beyond the base 30 minutes
  • Must be billed with 99491 in the same month
  • Reflects additional physician time spent on CCM activities

Billing Rules & Constraints

Only One CCM Series per Patient per Month

You cannot bill multiple CCM categories for a single patient in the same month. Pick the one that best matches the time and complexity of services provided:

Standard CCM (99490 + 99439 units)
Complex CCM (99487 + 99489 units)
Physician-Driven CCM (99491 + 99437 units)

Patient Eligibility

Two or more chronic conditions expected to last at least 12 months or until death
Documented care plan
24/7 access to care management services

Time Tracking

Track cumulative time by staff category each calendar month
Document clearly which team members delivered services
Map time units to correct add-on code structure (20- or 30-minute blocks)

Example Billing Scenarios

Service ScenarioBilling Codes
25 minutes clinical staff CCM99490
45 minutes clinical staff CCM99490 + 99439
90 minutes complex case99487 + 99489
65 minutes physician-led CCM99491 + 99437
Standard CCM with >60 mins99490 + (99439 × 2)

Implementation Considerations

Track cumulative time by staff category each calendar month
Ensure patient eligibility criteria are met (2+ chronic conditions, documented care plan)
Map time units to correct add-on code structure (20- or 30-minute blocks)
Validate series exclusivity at claim generation
Document clearly which team members delivered services
Note: Always verify with the latest CMS Fee Schedule and payer policies before claim submission.
Key Takeaways

Chronic Care Management enables practices to bill for coordinated care activities for patients with multiple chronic conditions. The 2026 CCM code structure supports three distinct service levels: Standard CCM for basic coordination, Complex CCM for higher complexity cases, and Physician-Driven CCM when clinicians personally provide services.

Three distinct CCM code series based on complexity
Only one CCM series per patient per month
Time-based billing with add-on codes for additional minutes