Chronic Care Management (CCM) is a Medicare-reimbursed program that compensates medical practices for providing coordinated, ongoing care to patients with two or more chronic conditions. The program pays practices monthly for qualifying care coordination activities performed outside of face-to-face visits—and in 2026, reimbursement rates increased approximately 10% from the previous year, one of the largest single-year jumps in program history.
That's the definition. Here's why it matters to your bottom line.
The average practice leaves 15,000 to 40,000 per month on the table by not billing CCM. One neurology practice generated $14,000 in net profit during its first month alone. A specialty group enrolled 440 patients in just 15 days. These aren't outliers. They're the results of proper CCM implementation.
Medicare beneficiaries qualify for CCM when they have two or more chronic conditions expected to last at least 12 months (or until death) that place them at significant risk of death, acute exacerbation, or functional decline.
The qualifying conditions list reads like a practice's patient roster: diabetes, hypertension, COPD, heart failure, chronic kidney disease, arthritis, depression, and dementia. Most practices find that 30-60% of their Medicare patient panel qualifies.
Patient consent is required before billing. A patient must verbally or in writing agree to participate, acknowledge that only one practitioner can bill CCM services per month, and understand cost-sharing responsibilities.
The qualification threshold: two chronic conditions lasting 12+ months with significant health risk. Most Medicare patients already meet it.
CCM billing centers on time-based CPT codes. The primary code—99490—requires a minimum of 20 minutes of clinical staff time per calendar month spent on care coordination activities.
Here's the complete CPT code breakdown for 2026:
CPT 99490 (Primary CCM Code)
Requirement: 20 minutes of clinical staff time
2026 Reimbursement: Approximately $66 (9.6% increase from 2025)
Billing frequency: Once per month per patient
CPT 99439 (Additional Time Add-On)
Requirement: Each additional 20 minutes beyond initial 20
2026 Reimbursement: Approximately $51 (10.1% increase from 2025)
Billing frequency: Up to 2 add-ons per month (for 60+ minutes total)
CPT 99491 (Complex CCM)
Requirement: 30 minutes of physician/QHP time
2026 Reimbursement: Approximately $89
Billing frequency: Once per month, cannot bill with 99490
CPT 99437 (Complex CCM Add-On)
Requirement: Each additional 30 minutes of physician/QHP time
2026 Reimbursement: Approximately $63
Billing frequency: Use with 99491 for extended complex care
The math scales quickly. A single patient receiving standard CCM (99490) generates roughly 792 annually. Add supplemental codes for additional time, and per-patient revenue climbs toward 1,300-$1,600 per year. Multiply across 200, 500, or 1,000+ enrolled patients.
2026 CCM reimbursement increased approximately 10% from 2025—one of the largest year-over-year increases in program history. CMS continues signaling that chronic care coordination is a priority.
CCM time includes any non-face-to-face care coordination activity. The CMS definition is broader than most practices realize.
Qualifying activities include:
Reviewing and revising comprehensive care plans
Communicating with patients via phone, secure messaging, or patient portal
Coordinating with specialists, pharmacies, hospitals, and home health agencies
Reconciling medications and addressing adherence issues
Documenting symptoms, vital signs, and health status changes
Arranging referrals and follow-up appointments
Monitoring test results and adjusting care accordingly
Educating patients and caregivers about chronic condition management
The 20-minute threshold seems modest. In practice, complex patients easily generate 40-60 minutes of coordination activity monthly—unlocking add-on codes and additional reimbursement.
Clinical staff time counts. Registered nurses, licensed practical nurses, medical assistants under clinical supervision, and certified care coordinators can all perform CCM activities. The supervising physician or qualified healthcare professional must be available but doesn't need to perform every task directly.
Any documented care coordination activity outside face-to-face visits counts toward CCM time. Most practices underestimate how much qualifying work already happens unreimbursed.
A Mathematica study commissioned by CMS found that CCM participation reduced hospitalizations and emergency department visits among enrolled beneficiaries. The clinical case is settled. The business case is equally compelling.
Consider the economics for a mid-sized practice:
Scenario: 300 enrolled CCM patients
Revenue at 99490 alone: 19,800/month (237,600/year)
Net profit after delivery costs: 10,000-13,000/month
Additional revenue from code stacking (99439, 99491): 3,500-7,000/month
One neurology practice documented 40-50 profit per patient per month after implementation costs. Their monthly program generated 15,833 in average net profit. Another practice—The Neurology Group—scaled from 5 providers to 20 with CCM serving as a core revenue pillar, generating 1.2 million annually.
Profitability depends on the delivery model. Software-only platforms require existing staff to perform outreach, documentation, and coordination—adding work to already-stretched teams. Full-service delivery partners provide the clinical staff, handle patient enrollment, perform monthly touchpoints, and manage billing. The upfront cost is higher, but net revenue per patient exceeds DIY approaches because billable engagement rates double.
CCM generates 40-50 net profit per patient monthly when delivered efficiently. The delivery model determines whether that profit actually materializes.
Two models dominate CCM implementation. Understanding the difference determines program success or failure.
Software-Only Platforms
Software platforms provide workflow tools, time tracking, and documentation templates. The practice's existing staff performs all patient outreach, care coordination, and billing activities.
The appeal: lower monthly cost per patient.
The reality: Most practices lack bandwidth. Staff already managing daily operations struggle to add 20+ minutes of monthly outreach per patient. Enrollment stalls. Engagement drops. Billing becomes inconsistent. The software sits unused while the vendor bills monthly fees.
Software-only models work for practices with dedicated care coordination staff already in place. For everyone else, they create another login for overwhelmed employees to ignore.
Full-Service Delivery Partners
Full-service partners provide dedicated clinical staff who handle enrollment, monthly patient engagement, documentation, and billing optimization. The practice maintains oversight while the partner functions as an extension of the care team.
The appeal: Revenue without operational burden.
The reality: Higher per-patient cost delivers higher per-patient profit because engagement rates climb. Partners with US-based clinical professionals achieve 45% enrollment rates compared to 10-15% typical of DIY programs. They bill multiple codes per patient where appropriate, capturing revenue that software-only approaches miss.
California Kidney Specialists grew connected care revenue from 220,000 to 450,000 annually by switching from internal management to a full-service partner. The Neurology Group reduced practice call volume by 50% while scaling CCM across their expanding provider network.
Software adds work to existing staff. Full-service partners add revenue without adding burden. The per-patient cost difference disappears when comparing net profit.
Launching CCM doesn't require months of preparation. Practices with clear processes can begin enrolling patients within weeks.
Step 1: Identify Qualifying Patients
Run a report of Medicare beneficiaries with two or more chronic conditions. Most EHR systems can generate this list from diagnosis codes. The Neurology Group identified over 3,000 qualifying patients in their existing panel before enrollment began.
Step 2: Establish Consent Process
Develop a patient consent workflow. Consent can be verbal (documented in the chart) or written. Explain the program benefits, monthly touchpoints, and any cost-sharing obligations. Effective enrollment scripts emphasize the care coordination value—not billing mechanics.
Step 3: Choose Delivery Model
Decide between internal staffing, software platform, or full-service partner. The decision hinges on available bandwidth. If current staff cannot dedicate 20+ minutes monthly per enrolled patient to outreach and documentation, external support becomes necessary.
Step 4: Configure Documentation and Billing
Ensure EHR and billing systems can capture CCM time, generate qualifying reports, and submit claims with appropriate CPT codes. Full-service partners typically handle this integration as part of implementation.
Step 5: Begin Enrollment and Outreach
Start with high-acuity patients most likely to benefit from care coordination. One practice enrolled 440 patients in 15 days by prioritizing engaged patients with complex conditions.
CCM implementation timelines range from 2-6 weeks depending on delivery model. First revenue typically arrives within 45-60 days of launch.
Sophisticated CCM programs bill beyond the base 99490 code. Patients with complex needs often qualify for multiple complementary codes within the same month.
CCM + BHI Stacking
Patients with qualifying chronic conditions AND behavioral health needs (depression, anxiety, dementia) can receive both CCM (99490) and Behavioral Health Integration (99484) billing. A patient might generate 66 from CCM and 52 from BHI in the same month—118 total versus 66 from CCM alone.
CCM + APCM Stacking
Advanced Primary Care Management (APCM), launched by CMS in 2025, provides additional reimbursement for intensive care management activities. The 2026 fee schedule increased APCM payments by approximately 10%, with the most common code (G0557) reimbursing $53.78 per patient monthly. Patients can enroll in both CCM and APCM simultaneously. APCM functions as gap coverage—when patients don't reach CCM's time-based threshold in a given month, they can still qualify for an APCM billable.
Time-Based Add-On Codes
Patients requiring more than 20 minutes of coordination time qualify for 99439 add-on codes. Billing 99490 + 99439 captures approximately 117 per patient monthly instead of 66.
One practice documented 583 total CCM codes billed in December across their enrolled population—far exceeding one code per patient—because their delivery partner identified and documented all qualifying activities rather than billing the minimum and moving on.
Single-code billing leaves money uncaptured. Code stacking strategies can double revenue per patient without adding patients.
Common CCM Mistakes to Avoid
Programs fail for predictable reasons. Avoiding these mistakes determines whether CCM becomes a revenue center or an abandoned initiative.
Mistake 1: Insufficient Enrollment Effort
Identifying qualifying patients means nothing without active enrollment. Practices expecting patients to opt-in passively see enrollment rates below 10%. Proactive outreach with trained enrollment specialists achieves 45% or higher.
Mistake 2: Inconsistent Monthly Engagement
CCM requires documented patient contact each billing month. Practices billing sporadically—engaging patients some months but not others—lose revenue and violate program requirements. Consistent monthly touchpoints aren't optional.
Mistake 3: Poor Documentation
Every minute of CCM time must be documented with specific activities performed. "Called patient" doesn't suffice. "Called patient to review medication list, discussed Metformin adherence challenges, coordinated with pharmacy on refill timing, updated care plan with new blood pressure reading" does.
Mistake 4: Ignoring Add-On Opportunities
Billing 99490 alone when patients generate 40+ minutes of coordination activity forfeits legitimate revenue. Track time accurately and bill all qualifying codes.
Mistake 5: Underestimating Staff Burden
Practices launching CCM with "we'll have our MAs handle it" frequently discover those MAs are already at capacity. Unrealistic staffing assumptions doom programs before they start.
Most CCM failures stem from operational execution, not program viability. The reimbursement opportunity is real. The implementation determines capture rate.
CCM represents one of the largest untapped revenue opportunities for practices serving Medicare populations. CMS continues expanding reimbursement rates—the 2026 fee schedule delivered approximately 10% increases across CCM codes, signaling ongoing commitment to care coordination. Patients with chronic conditions benefit from coordinated care. Practices billing appropriately generate 40-50 net profit per patient monthly.
The question isn't whether CCM makes financial sense. It does. The question is whether your practice has the operational infrastructure to capture that revenue—or whether a delivery partner makes more sense.
Practices that enroll 300+ patients, maintain consistent monthly engagement, and bill all qualifying codes generate 175,000 to 450,000 in annual CCM revenue. Those that attempt CCM without adequate staffing or systems join the list of programs that started strong and quietly disappeared.
Chronic Care Management pays practices to do what good medicine already requires: coordinate ongoing care for complex patients. The only variable is whether that care gets documented and billed.
Ready to evaluate CCM for your practice? Set up a consultation with us.