CPT 99490E&M

Chrnc care mgmt staff 1st 20

CPT 99490 covers the first 20 minutes of monthly chronic care management services provided by clinical staff under physician supervision for patients with two or more chronic conditions.

Showing rates for

National Average

Base Medicare rate

$60.49

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

PE RVU (NF)

0.81

MP RVU

0.06

Total RVU

1.87

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill only once per calendar month regardless of when 20 minutes are accumulated; do not prorate for partial months
Impact: Prevents denials for duplicate billing; ensures full $60.49 payment per qualifying month
Obtain and document written patient consent before billing first CCM service, including disclosure of potential cost-sharing responsibilities
Impact: Required for payment; missing consent documentation is the #1 audit trigger resulting in 100% recoupment
Use separate time tracking logs for CCM minutes distinct from time spent during face-to-face visits; only non-face-to-face time counts toward the 20-minute threshold
Impact: Prevents bundle denials and supports audit defense; time during E&M visits cannot count toward 99490
Bill commercial payers at 200-250% of Medicare rate ($120-150) as CCM codes are often undervalued in fee schedules
Impact: Potential revenue increase of $60-90 per patient per month with proper contract negotiation
Ensure comprehensive care plan is documented and shared with patient (or caregiver) and available 24/7 to on-call providers electronically
Impact: Core documentation requirement; missing care plan results in denial with $60.49 recoupment plus potential fraud investigation
Do not bill 99490 in same month as transitional care management (99495-99496), principal care management (99424-99427), or other time-based CCM codes
Impact: Mutually exclusive services; duplicate billing triggers automatic denial and potential prepayment review

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Frequently asked questions

How much does Medicare pay for CPT code 99490 in 2025?

Medicare pays $60.49 for CPT 99490 in 2025 under the non-facility rate (national average). The facility rate is $47.87. The code has 1.87 total RVUs with a work RVU of 1.0.

What is the minimum time requirement to bill 99490?

You must provide at least 20 minutes of non-face-to-face chronic care management services per calendar month to bill CPT 99490. Time spent during face-to-face office visits does not count toward this minimum. Services under 20 minutes cannot be billed.

Can I bill 99490 and a regular office visit on the same day?

You can bill an E&M office visit and 99490 in the same calendar month, but the time spent during the face-to-face visit does not count toward the 20-minute CCM requirement. The 99490 time must be separate non-face-to-face care coordination time accumulated throughout the month.

Do I need patient consent to bill 99490 chronic care management?

Yes, written patient consent is mandatory before billing CPT 99490. The consent must inform patients of cost-sharing responsibilities, their right to decline services, and ability to stop CCM at any time. Missing consent documentation is the most common reason for claim denials and audit recoupments.

How many chronic conditions does a patient need to qualify for 99490?

The patient must have at least two chronic conditions expected to last 12 months or more, or until the patient's death, and that place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.

Can I bill 99490 and 99491 in the same month?

No, you cannot bill both 99490 and 99491 in the same calendar month for the same patient. These are mutually exclusive codes. Bill 99490 for 20-39 minutes of CCM time, or 99491 for 60+ minutes, but only one CCM code per patient per month.

Who can perform the services for CPT 99490?

Clinical staff including registered nurses, licensed practical nurses, medical assistants, or health coaches can perform 99490 services under the general supervision of a physician or qualified healthcare professional. The supervising provider must be available for consultation and must bill for the service.