Reimbursement
$66.13
Threshold
20m
2026 Status
Active
What is CPT Code 99490?
CPT 99490 is defined as: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; establishment, implementation, revision, or monitoring of a comprehensive care plan.
This code is primarily used for CCM services. It falls under the category of Care Management / CCM and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1
Physician Effort
PE (Non-Fac)
0.91
Practice Expense
Malpractice
0.07
Risk Factor
Total RVU
1.98
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% productivity adjustment applied to procedural codes.
fqhc rhc transition
G0511 is sunsetted. FQHC/RHC facilities must now bill 99490 to capture specific resource intensity.
conversion factor spread
Payments vary by provider status: $33.40 (Non-QP) vs $33.57 (QP).
site of service differential
PE value favors Office (POS 11) over Facility (POS 22) due to indirect cost redistribution.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
minimum time
20 minutes per calendar month
staff type
Clinical staff (MA, LPN, RN) under general supervision of a Physician or QHP
frequency
Once per calendar month
add on codes
99439
care plan requirement
Comprehensive electronic care plan available 24/7 to all providers within the practice.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare focus has shifted to 'Longitudinal Continuity'. CPT 99490 is the primary vehicle for this mandate.
Common Clinical Scenarios
CMS Eligibility: Must have 2 or more chronic conditions. Conditions expected to last 12+ months or until death
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99491
99491 is for 30+ min of PERSONALLY provided time by MD/NP/PA; 99490 is for clinical staff time.
VS 99487
99487 (Complex CCM) requires 60+ min and 'Substantial Revision' of the care plan.
VS 99424
99424 (PCM) is for a single complex condition managed by a specialist.
Frequently Asked Questions
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